Nicole Antes, RD
Individual provider Active NPI Registered Dietitian · Glendale, AZ
NPI 1356042535 · NPPES record last updated Mar 14, 2023
Key facts
- NPI
- 1356042535
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 86294431 (AZ)
- Practice address
- 18001 N 79TH Ave Ste A12
Glendale, AZ 85308-8398 - Phone
- (623) 399-6825
- Fax
- (623) 505-3474
- NPI assigned
- Mar 14, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86294431 | AZ | MD | Registered Dietitian |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86294431 | AZ | Yes |
Addresses
Primary practice location
18001 N 79TH Ave Ste A12
Glendale, AZ 85308-8398
Mailing address
18001 N 79TH Ave Ste A12
Glendale, AZ 85308-8398
Phone (623) 399-6825
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All providers in Glendale, AZ · Registered Dietitian in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 14, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.