Individual
MRS. DIANA M NICOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CDE
Contact information
Practice address
8300 CONSTITUTION AVE NE BLD D, ALBUQUERQUE, NM 87110
(505) 559-6404
Mailing address
4252 TRINITY PL NW, ALBUQUERQUE, NM 87107
(505) 850-8430
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
LD-1263
NM
133V00000X
Registered Dietitian
LD-1263
NM
Other
Enumeration date
12/18/2018
Last updated
01/14/2021
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