Individual
NICOLE HERMOSILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
20 YORK STREET FOOD AND NUTRITION, EPB806, NEW HAVEN, CT 06510-3220
(203) 688-3732
Mailing address
20 YORK STREET FOOD AND NUTRITION, EPB806, NEW HAVEN, CT 06510
(203) 688-3732
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1029067
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C02658
MEDICARE YNHH MEDICARE NUMBER
CT
Enumeration date
06/10/2016
Last updated
06/10/2016
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