Individual
LYNN ANASTASIA NICKOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
4100 W 3RD ST, DAYTON, OH 45428-9000
(317) 430-4191
Mailing address
7114 LAKESIDE WOODS DR, INDIANAPOLIS, IN 46278-1658
(317) 430-4191
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
707725
—
Other
Enumeration date
09/14/2018
Last updated
09/14/2018
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