Provider Demographics
NPI:1164204541
Name:MCARDLE, NICOLE JENSSEN (RD)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:JENSSEN
Last Name:MCARDLE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:JENSSEN
Other - Last Name:CARTWRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:7158 BROWNS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-8538
Mailing Address - Country:US
Mailing Address - Phone:707-761-4191
Mailing Address - Fax:
Practice Address - Street 1:7158 BROWNS VALLEY RD
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-8538
Practice Address - Country:US
Practice Address - Phone:707-761-4191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2025-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86211528133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered