Individual
MELISSA A. NICOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DIETICIAN
Contact information
Practice address
415 N 9TH ST, STE 6W100, SPRINGFIELD, IL 62702-5303
(217) 545-8000
(217) 545-9217
Mailing address
PO BOX 19640, SPRINGFIELD, IL 62794-9640
(217) 545-8000
(217) 545-9217
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164005484
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
164.005484
STATE OF ILLINOIS LICENSE
IL
Enumeration date
07/25/2011
Last updated
11/15/2013
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