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NPI Code Detail

MEDICARE: NICOLE DEAN RD,LDN,CNSC

MEDICARE: NICOLE DEAN RD,LDN,CNSC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered DietitianDN002287PA
2133V00000XRegistered Dietitian867433PA

General Provider Information

NPI Number : 1063712396
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE DEAN RD,LDN,CNSC
Provider Business Mailing Address
First Line : 8151 RIDGE AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19128-2902
Country : US
Telephone Number : 215-487-2500
Fax Number :
Provider Business Practice Location Address
First Line : 8151 RIDGE AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19128-2902
Country : US
Telephone Number : 215-487-2500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2010
Last Update Date : 07/31/2011

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Directions to “ NICOLE DEAN RD,LDN,CNSC” Practice Location

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