Individual
NICOLE LEIGH LAVERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LDN
Contact information
Practice address
12 S 23RD ST, PHILADELPHIA, PA 19103-3014
(215) 496-2662
Mailing address
PO BOX 30181, PHILADELPHIA, PA 19103-8181
(215) 496-2662
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DN003704
PA
Other
Enumeration date
07/10/2008
Last updated
07/10/2008
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