Provider Demographics
NPI:1174159123
Name:STAHLE, NICHOLE LAURA (RDN, CD)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:LAURA
Last Name:STAHLE
Suffix:
Gender:F
Credentials:RDN, CD
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:LAURA
Other - Last Name:LITTLEFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2111 N HILL FIELD RD UNIT D235
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5192
Mailing Address - Country:US
Mailing Address - Phone:801-513-9711
Mailing Address - Fax:
Practice Address - Street 1:1600 W ANTELOPE DR
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1120
Practice Address - Country:US
Practice Address - Phone:801-807-7179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11056478-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered