Provider Demographics
NPI:1558099374
Name:ROSADO HERNANDEZ, NICOLLE LORRAINE (RDN)
Entity type:Individual
Prefix:
First Name:NICOLLE
Middle Name:LORRAINE
Last Name:ROSADO HERNANDEZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND. ALTURAS DE MAYAGUEZ 325 AVE ALGARROBO
Mailing Address - Street 2:APT 8H
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-612-4015
Mailing Address - Fax:
Practice Address - Street 1:COND. ALTURAS DE MAYAGUEZ 325 AVE ALGARROBO
Practice Address - Street 2:APT 8H
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-612-4015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR86071737133V00000X
PR2199133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist