Individual
MALLORY JO NICHOLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
1990 GRAND AVE, WEST DES MOINES, IA 50265-4222
(515) 223-8151
Mailing address
1990 GRAND AVE, WEST DES MOINES, IA 50265-4222
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
002117
IA
Other
Enumeration date
11/12/2013
Last updated
11/12/2013
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