Provider Demographics
NPI:1487424123
Name:MCGRATH, NICOLE (RD,LD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13636 AMODIO AVE NW
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8448
Mailing Address - Country:US
Mailing Address - Phone:330-606-9415
Mailing Address - Fax:
Practice Address - Street 1:13636 AMODIO AVE NW
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-8448
Practice Address - Country:US
Practice Address - Phone:330-606-9415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4991133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered