Nicole Wavra

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

1454 Issued in MN

Practice address

2230 Como Ave
Saint Paul, MN 55108-1720

Phone

(651) 645-5323

NPI assigned

Oct 23, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Relate Nutrition & Therapy

  • Marriage & Family Therapist
  • Minneapolis, MN
  • NPI 1073171534

  Dietitian, Registered

  NPD (past) Authorized official

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

{
    "created_epoch": "1445558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445558400000",
    "number": "1649642182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 NEPTUNE ST",
            "city": "MAHTOMEDI",
            "state": "MN",
            "postal_code": "551151956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2230 COMO AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551081720",
            "telephone_number": "651-645-5323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAVRA",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-23",
        "last_updated": "2015-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MN",
            "license": "1454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Watkins
• Tina Watson Wiens, MA, LMFT
• Emma Grace Watson, PT, DPT
• Mark Douglas Watson, D.D.S.
• Theressa Watt, MA, LMFT
• George Wawro, LADC, MSW, LICSW
• Way-Maker Solutions LLC
• June N Way
• Christa Lane Waymire, M.D.
• Shelley M Wayne Healy, D.P.M

• Registered Dietitian in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Registered Dietitian in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2015; 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.