Individual
NICOLE WAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., R.D.
Contact information
Practice address
179 N BROAD ST, NORWICH, NY 13815-1019
(607) 337-4812
(607) 337-4198
Mailing address
145 CO RD 32A, NORWICH, NY 13815
(607) 373-7410
(607) 337-4198
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1019080
NY
Other
Enumeration date
05/06/2015
Last updated
07/01/2020
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