Provider Demographics
NPI:1194883009
Name:MILLER, NICOLLE MARIE (MS, MPH, RD, LDN)
Entity type:Individual
Prefix:
First Name:NICOLLE
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, MPH, RD, LDN
Other - Prefix:
Other - First Name:NICOLLE
Other - Middle Name:MARIE
Other - Last Name:CLEMENTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 W DUTTON CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-5119
Mailing Address - Country:US
Mailing Address - Phone:201-600-3447
Mailing Address - Fax:
Practice Address - Street 1:108 W DUTTON CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-5119
Practice Address - Country:US
Practice Address - Phone:201-600-3447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
942690133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered