NPI 1073089934

Nicole Kristina Derse, CNC

Practitioner Nutritionist Appleton, WI

Practice location

Address: 308 E Glendale Ave, Appleton, WI 54911-2907
Phone: (920) 322-5115

Registered specialties

Nutritionist Primary

Dietary & Nutritional Service Providers Taxonomy 133N00000X Licence 12D577516 (WI)

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Registry record

NPI: 1073089934
Entity type: Individual
Sex (as registered): Female
NPI issued: 18 Oct 2018
Record last updated: 18 Oct 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.