Provider Demographics
NPI:1376297762
Name:NICHOLSON, ANDREA (BCHN, NTM, RWP-3)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:BCHN, NTM, RWP-3
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 N PINE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2421
Mailing Address - Country:US
Mailing Address - Phone:303-815-8108
Mailing Address - Fax:
Practice Address - Street 1:3250 N PINE VIEW DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2421
Practice Address - Country:US
Practice Address - Phone:303-815-8108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-05
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist