| Doctor Name: | NICOLE WAKE |
| NPI Number: | 1073990362 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S.,R.D.,C.D.N. |
| License Number: | 1019080 |
| Business Practice Address: | 179 N Broad St Norwich, NY - 138151019 |
| Business Phone Number: | 6073374812 |
| Business Fax Number: | 6073374198 |
| Mailing Address: | 179 N Broad St, NORWICH |
| State: | NY |
| Postal Code: | 138151019 |
| Phone Number: | 6073374812 |
| Fax Number: | 6073374198 |
| NPI Enumeration Date: | 05/06/2015 |
| NPI Last Update Date: | 05/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 1019080 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |