Healthcare Provider Details

I. General information

NPI: 1841240140
Provider Name (Legal Business Name): NICOLE GREENWAY LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BREWSTER ST FOOD & NUTRITION DEPT.
PAWTUCKET RI
02860-4400
US

IV. Provider business mailing address

111 BREWSTER ST FOOD & NUTRITION DEPT.
PAWTUCKET RI
02860-4400
US

V. Phone/Fax

Practice location:
  • Phone: 401-729-2574
  • Fax: 401-729-3663
Mailing address:
  • Phone: 401-729-2574
  • Fax: 401-729-3663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN00464
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: