Provider Demographics
NPI:1700066909
Name:STARR, NICOLE L (RD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:STARR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-544-2935
Mailing Address - Fax:717-544-3935
Practice Address - Street 1:2150 HARRISBURG PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-2935
Practice Address - Fax:717-544-3935
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000016133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered