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Theresa Renee Nickolaus, RD, LD, IBCLC

NPI #1922774751 in Imperial, Missouri

Provider Information

NPI Number
1922774751
Entity Type
Individual
Name
Theresa Renee Nickolaus, RD, LD, IBCLC
Gender
Not Specified
Sole Proprietor
Yes
Primary Specialty
Dietitian, Registered
Credential
RD, LD, IBCLC
Enumeration Date
Aug 20, 2021
Last Updated
Aug 20, 2021

Practice Location

Address
1011 SCENIC OAKS CT
City
Imperial
State
Missouri
ZIP Code
63052-3457
Phone
(314) 363-6186

Specialties & Taxonomy Codes

Specialty
Lactation Consultant, Non-RN
Dietitian, Registered

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