MEDICARE: BRAG 'GI NICOLE WILLIAMS

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
1	133V00000X	Registered Dietitian	86278250	OH

General Provider Information

NPI Number	:	1760332431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRAG 'GI NICOLE WILLIAMS

Provider Business Mailing Address
First Line	:	14986 E SUNSET MAPLE DR
Second Line	:
City	:	PERRYSBURG
State	:	OH
Zip	:	43551-1491
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14986 E SUNSET MAPLE DR
Second Line	:
City	:	PERRYSBURG
State	:	OH
Zip	:	43551-1491
Country	:	US
Telephone Number	:	614-390-3253
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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