Basic Information
| Provider Information | |||||||||
| NPI: | 1306388624 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NYCE | ||||||||
| FirstName: | JEANETTE | ||||||||
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| Credential: | RDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 909 PROGRESS CIR | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218042323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106771040 | ||||||||
| FaxNumber: | 4109125748 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 E CARROLL ST | ||||||||
| Address2: | ATTENTION: ANGIE RUTKOWSKI | ||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218015422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105437531 | ||||||||
| FaxNumber: | 4109124972 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2016 | ||||||||
| LastUpdateDate: | 11/17/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DX3456 | MD | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.