Active NPI
Nicole Wake, M.S., R.D.
- Registered Dietitian
- Norwich, NY
National Provider Identifier
1073990362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1019080
- Practice address
- 179 N Broad St
Norwich, NY 13815-1019 - Phone
- (607) 337-4812
- Fax
- (607) 337-4198
- NPI assigned
- May 6, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 1019080 | NY | Primary |
Addresses
Primary practice location
179 N Broad St
Norwich, NY 13815-1019
Mailing address
145 Co Rd 32a
Norwich, NY 13815
Phone (607) 373-7410
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1019080 | NY | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
| Allara Medical Group PA | Past | Accepting new patients |
Interoperability endpoints
- nicole.wake@335000925634564.direct.elationemr.com
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Gynecology Physician
- New York, NY
- NPI 1700450558
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1430870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593561600000",
"number": "1073990362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "145 CO RD 32A",
"city": "NORWICH",
"state": "NY",
"postal_code": "13815",
"telephone_number": "607-373-7410",
"fax_number": "607-337-4198"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "179 N BROAD ST",
"city": "NORWICH",
"state": "NY",
"postal_code": "138151019",
"telephone_number": "607-337-4812",
"fax_number": "607-337-4198"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAKE",
"first_name": "NICOLE",
"credential": "M.S., R.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-05-06",
"last_updated": "2020-07-01",
"certification_date": "2020-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NY",
"license": "1019080",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norwich, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.