Provider Demographics
NPI:1861080194
Name:MCCOLLIN, MONICA MARIE-NICOLE (CNS, LDN, RYT)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:MARIE-NICOLE
Last Name:MCCOLLIN
Suffix:
Gender:F
Credentials:CNS, LDN, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7609 RAVEN PL
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19153-2104
Mailing Address - Country:US
Mailing Address - Phone:202-441-8239
Mailing Address - Fax:
Practice Address - Street 1:7609 RAVEN PL
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19153-2104
Practice Address - Country:US
Practice Address - Phone:202-441-8239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005200133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty