Provider Demographics
NPI:1174975296
Name:NICHOL, MELANIE JEANNETTE (RD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:JEANNETTE
Last Name:NICHOL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DEER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-9282
Mailing Address - Country:US
Mailing Address - Phone:970-366-6017
Mailing Address - Fax:
Practice Address - Street 1:11 DEER VALLEY DR
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-9282
Practice Address - Country:US
Practice Address - Phone:970-366-6017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO832287133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered