Nicole Marie Nutrition LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

NICOLE MARIE NUTRITION LLC

Practice address

1150 First Ave Ste 501
King of Prussia, PA 19406-1316

Phone

(484) 985-2401

Fax

(610) 935-4820

NPI assigned

Apr 29, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicole Bergoine

Title

Owner

Phone

(484) 985-2401

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1556496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556496000000",
    "number": "1013571611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 FIRST AVE STE 501",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194061316",
            "telephone_number": "484-985-2401",
            "fax_number": "610-935-4820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 FIRST AVE STE 501",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194061316",
            "telephone_number": "484-985-2401",
            "fax_number": "610-935-4820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICOLE MARIE NUTRITION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-29",
        "last_updated": "2019-04-29",
        "status": "A",
        "authorized_official_last_name": "BERGOINE",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "484-985-2401"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Newell
• Lorene Newman, CRNA
• Andy Nguyen
• My Le Nguyen, PHARMD
• Jaclyn Marie Nicodemo, LMT
• Gabriel Arturo Noble Cruz, MD
• Obed Antonio Nogueda
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• Registered Dietitian in King of Prussia, PA
• Providers in King of Prussia, PA by specialty
• Registered Dietitian in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.