Provider Demographics
NPI:1013498328
Name:WILLIAMS, NICOLE LEE (RD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LEE
Other - Last Name:EHRHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:302 EL CAMINO REAL STE A
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2860
Mailing Address - Country:US
Mailing Address - Phone:520-255-5475
Mailing Address - Fax:855-801-7998
Practice Address - Street 1:302 EL CAMINO REAL STE A
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2860
Practice Address - Country:US
Practice Address - Phone:520-255-5475
Practice Address - Fax:855-801-7998
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ871698133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered