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General NPI Number Information
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NPI Number | 1962593665
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Entity Type | Individual
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Provider Name | NICOLE THERIAULT RD, LD
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Gender | Female
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 06/03/2026
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Provider Practice Location Address
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Address Line | 140 ACADEMY ST
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City | PRESQUE ISLE
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State | ME
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Zip | 04769-3102
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Country | US
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Telephone | 207-768-4358
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Fax |
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Provider Business Mailing Address
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Address Line | 39 ECHO LAKE RD
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City | PRESQUE ISLE
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State | ME
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Zip | 04769-5252
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Country | US
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Telephone |
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Fax |
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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 | D1710
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License Number State | ME
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