1578772844 NPI number — MS. SUSAN ANN NICHOLS MS,RD,CDE,CDN

Table of content: MS. SUSAN ANN NICHOLS MS,RD,CDE,CDN (NPI 1578772844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578772844 NPI number — MS. SUSAN ANN NICHOLS MS,RD,CDE,CDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NICHOLS
Provider First Name:
SUSAN
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS,RD,CDE,CDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCARUPA
Provider Other First Name:
SUSAN
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSRDCDECDN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578772844
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 ESSEX CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTONVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10992-1365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-497-7496
Provider Business Mailing Address Fax Number:
845-496-1187

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 ESSEX CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTONVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10992-1365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-497-7496
Provider Business Practice Location Address Fax Number:
845-496-1187
Provider Enumeration Date:
05/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  000197 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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