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NPI 1073089934

IndividualActive

Nicole Derse, CNC

NPI 1073089934 · Nutritionist · Appleton, WI

Provider details

NPI number: 1073089934
Entity type: Individual
Primary specialty: NutritionistDietary & Nutritional Service Providers
Credential: CNC
Sex: Female
Sole proprietor: No
License: 12D577516 (WI)

Practice location

308 E Glendale Ave

Appleton, WI 54911-2907

Phone: (920) 322-5115

More WI providers

Mailing address

308 E Glendale Ave

Appleton, WI 54911-2907

Registry dates

Enumerated: 2018-10-18
Last updated: 2018-10-18

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.

Nicole Derse, CNC — NPI 1073089934, Appleton, WI | NPI Central