Provider Demographics
NPI:1396573788
Name:NICOLE BAKER NUTRITION LLC
Entity type:Organization
Organization Name:NICOLE BAKER NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:OLIVIA
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, CNSC
Authorized Official - Phone:269-924-6905
Mailing Address - Street 1:164 THELMA DR
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-7831
Mailing Address - Country:US
Mailing Address - Phone:269-924-6905
Mailing Address - Fax:888-370-4987
Practice Address - Street 1:164 THELMA DR
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-7831
Practice Address - Country:US
Practice Address - Phone:269-924-6905
Practice Address - Fax:888-370-4987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty