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General NPI Number Information
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NPI Number | 1619335684
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Entity Type | Individual
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Provider Name | DARLENE NICHOLS RD
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Gender | Female
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Dates
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Enumeration Date | 02/05/2016
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 4205 FOREST PARK AVE DIV IM NEPHROLOGY
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City | SAINT LOUIS
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State | MO
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Zip | 63108-2810
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Country | US
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Telephone | 314-286-0800
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Fax | 314-286-0855
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Provider Business Mailing Address
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Address Line | PO BOX 60352
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City | SAINT LOUIS
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State | MO
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Zip | 63160-0352
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Country | US
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Telephone | 314-286-0800
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Fax | 314-286-0855
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 2001012154
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License Number State | MO
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