Healthcare Provider Details

I. General information

NPI: 1477489730
Provider Name (Legal Business Name): NICOLE HOLLAND RDN, RD, CD, MSAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1859 N MARIS ST
TOOELE UT
84074-8032
US

IV. Provider business mailing address

1859 N MARIS ST
TOOELE UT
84074-8032
US

V. Phone/Fax

Practice location:
  • Phone: 801-635-5793
  • Fax:
Mailing address:
  • Phone: 801-635-5793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number14296023-4901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: