Individual
MRS. NICOLE L HANCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
35629 HIGHWAY 72, SALEM, MO 65560-7217
(573) 729-5917
(573) 729-5636
Mailing address
1084 COUNTY ROAD 2630, SALEM, MO 65560-7967
(417) 547-3373
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2010033235
MO
133V00000X
Registered Dietitian
2460
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003775591
UHC MPIN
MO
01
—
0957151
CIGNA PID
MO
01
—
26D0446923
CLIA (TCMH)
MO
05
—
350081231
—
MO
Enumeration date
01/13/2014
Last updated
07/08/2020
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