Provider Demographics
NPI:1124901871
Name:NICOLE SPEENEY NUTRITION LLC
Entity type:Organization
Organization Name:NICOLE SPEENEY NUTRITION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:BRYNNA
Authorized Official - Last Name:SPEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS RDN LDN
Authorized Official - Phone:215-375-8900
Mailing Address - Street 1:1754 CASTLE PEAK DR
Mailing Address - Street 2:
Mailing Address - City:RURAL HALL
Mailing Address - State:NC
Mailing Address - Zip Code:27045-9164
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1754 CASTLE PEAK DR
Practice Address - Street 2:
Practice Address - City:RURAL HALL
Practice Address - State:NC
Practice Address - Zip Code:27045-9164
Practice Address - Country:US
Practice Address - Phone:215-375-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-29
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty