Individual
MRS. NICOLE MARIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. R.D.
Contact information
Practice address
2 CRESCENT PARK WEST, NUTRITION SERVICES, WARREN, PA 16365
(814) 723-4973
Mailing address
2 CRESCENT PARK WEST, NUTRITION SERVICES, WARREN, PA 16365
(814) 723-4973
Taxonomy
Speciality
Code
Description
License number
State
132700000X
Dietary Manager
—
—
133V00000X
Registered Dietitian
Primary
1004345
NY
Other
Enumeration date
09/23/2009
Last updated
09/23/2009
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