Provider Demographics
NPI:1194276535
Name:NICHOLS, ELIZABETH CLAIRE (RD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CLAIRE
Last Name:NICHOLS
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 1:6502 NE 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-1305
Mailing Address - Country:US
Mailing Address - Phone:360-693-0939
Mailing Address - Fax:
Practice Address - Street 1:6502 NE 47TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-1305
Practice Address - Country:US
Practice Address - Phone:360-693-0939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered