Provider Demographics
NPI:1366856858
Name:AVALOS, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:AVALOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1427
Mailing Address - Country:US
Mailing Address - Phone:419-874-7451
Mailing Address - Fax:419-874-8218
Practice Address - Street 1:112 W FRONT ST
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1427
Practice Address - Country:US
Practice Address - Phone:419-874-7451
Practice Address - Fax:419-874-8218
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist