Provider Demographics
NPI:1215158985
Name:NICHOL, BRENDA LIANNE (RD,CDE,LDN)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LIANNE
Last Name:NICHOL
Suffix:
Gender:F
Credentials:RD,CDE,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 OCTOBER DR
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16002-7552
Mailing Address - Country:US
Mailing Address - Phone:724-287-0280
Mailing Address - Fax:
Practice Address - Street 1:911 E BRADY ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-4646
Practice Address - Country:US
Practice Address - Phone:724-477-3049
Practice Address - Fax:724-284-4292
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001434133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered