Provider Demographics
NPI:1043854003
Name:NIMMONS, KAREN E (RDN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:NIMMONS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14940 258TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-3025
Mailing Address - Country:US
Mailing Address - Phone:718-949-8931
Mailing Address - Fax:
Practice Address - Street 1:14940 258TH ST
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-3025
Practice Address - Country:US
Practice Address - Phone:718-949-8931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-03
Last Update Date:2019-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered