Provider Demographics
NPI:1467692343
Name:MORGAN, NICOLE (MS RDN LD CDE)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MS RDN LD CDE
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MORGAN
Other - Last Name:HANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, MS, LD, CDE
Mailing Address - Street 1:1480 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-3461
Mailing Address - Country:US
Mailing Address - Phone:541-601-3045
Mailing Address - Fax:844-400-1768
Practice Address - Street 1:1480 OREGON ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-3461
Practice Address - Country:US
Practice Address - Phone:541-601-3045
Practice Address - Fax:844-400-1768
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR670133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered