=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245903624
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE VARELA RDN, LDN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2021
-----------------------------------------------------
Last Update Date | 03/19/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | BLDG. 81501 BISSEL ST.
-----------------------------------------------------
City | FORT HUACHUCA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-533-8894
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 90312 MACHOL AVE.
-----------------------------------------------------
City | FORT HUACHUCA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-533-8894
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 86042713
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------