Provider Demographics
NPI:1902576135
Name:HAVALA, NICAELA DURELLE (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:NICAELA
Middle Name:DURELLE
Last Name:HAVALA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 ALPHA RD STE 80-23
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-4355
Mailing Address - Country:US
Mailing Address - Phone:972-821-9557
Mailing Address - Fax:972-525-4731
Practice Address - Street 1:5301 ALPHA RD STE 80-23
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-4355
Practice Address - Country:US
Practice Address - Phone:972-821-9557
Practice Address - Fax:972-525-4731
Is Sole Proprietor?:No
Enumeration Date:2021-09-18
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86109133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered