Nicole Davis, MS, RDN, LDN | |
1006 S Division St, Carterville, IL 62918-1539 | |
(618) 519-9200 | |
(618) 985-3774 |
Full Name | Nicole Davis |
---|---|
Gender | Female |
Speciality | Dietitian, Registered |
Location | 1006 S Division St, Carterville, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1871975938 | NPI | - | NPPES |
1065198 | Other | COMMISSION ON DIETETIC REGISTRATION |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
133V00000X | Dietitian, Registered | 164.006153 (Illinois) | Primary |
Provider Name | Shawnee Health Service And Development Corp |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1639295314 PECOS PAC ID: 1658285671 Enrollment ID: O20031120000454 |
Mailing Address | Practice Location Address |
---|---|
Nicole Davis, MS, RDN, LDN 109 California St, Po Box 577, Carterville, IL 62918 Ph: (618) 519-9200 | Nicole Davis, MS, RDN, LDN 1006 S Division St, Carterville, IL 62918-1539 Ph: (618) 519-9200 |
Lacie Diane Hawkins, RD-LDN Dietitian Medicare: Not Enrolled in Medicare Practice Location: 1006 S Division St, Carterville, IL 62918 Phone: 618-985-4841 Fax: 618-985-8101 | |
Gail L Peterman, RD Dietitian Medicare: Accepting Medicare Assignments Practice Location: 1006 S Division St, Carterville, IL 62918 Phone: 618-519-9200 Fax: 618-985-3774 | |
Mrs. Natalie J. Demello, RD, LDN, CDE Dietitian Medicare: Not Enrolled in Medicare Practice Location: 304 Excalibur, Carterville, IL 62918 Phone: 618-889-9440 |