Provider Demographics
NPI:1962110395
Name:HODAC, NICOLE (MS, RDN, CSO, LD)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:HODAC
Suffix:
Gender:F
Credentials:MS, RDN, CSO, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 CLOUDED WREN DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76005-1342
Mailing Address - Country:US
Mailing Address - Phone:937-422-5395
Mailing Address - Fax:
Practice Address - Street 1:1815 CLOUDED WREN DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76005-1342
Practice Address - Country:US
Practice Address - Phone:937-422-5395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83860133VN1301X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology