Provider Demographics
NPI:1194142505
Name:ROWRAY, NICOLE (RDN, CSR, LD, CLT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ROWRAY
Suffix:
Gender:F
Credentials:RDN, CSR, LD, CLT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:PAASCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4605 INDIAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-9654
Mailing Address - Country:US
Mailing Address - Phone:319-360-8615
Mailing Address - Fax:
Practice Address - Street 1:5264 COUNCIL ST NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402
Practice Address - Country:US
Practice Address - Phone:319-398-6477
Practice Address - Fax:319-398-6434
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01730133N00000X, 133VN1005X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal