MEDICARE: NICOLE L MYERS RD

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	998049	VT
2	133V00000X	Registered Dietitian	998049	NC
3	133V00000X	Registered Dietitian	L004854	NC
4	133V00000X	Registered Dietitian	2910	MA

General Provider Information

NPI Number	:	1881976884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE L MYERS RD

Provider Business Mailing Address
First Line	:	3 PHILLIPS PL
Second Line	:
City	:	HADLEY
State	:	MA
Zip	:	01035-3515
Country	:	US
Telephone Number	:	917-626-1027
Fax Number	:	413-707-1027

Provider Business Practice Location Address
First Line	:	25 PRAY ST
Second Line	:
City	:	AMHERST
State	:	MA
Zip	:	01002-2110
Country	:	US
Telephone Number	:	917-626-1027
Fax Number	:	413-707-1027

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

Provider Enumeration Date	:	09/15/2011
Last Update Date	:	07/24/2023

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Directions to “ NICOLE L MYERS RD” Practice Location

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