Provider Demographics
NPI:1871131045
Name:SCOTT-HARRIS, NICOLE (RDN)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:SCOTT-HARRIS
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 1:590 BLOOMFIELD AVE UNIT 299
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2510
Mailing Address - Country:US
Mailing Address - Phone:973-902-3398
Mailing Address - Fax:
Practice Address - Street 1:470 PROSPECT AVE STE 100
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4106
Practice Address - Country:US
Practice Address - Phone:973-780-4609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86058791133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered