NPI
Theresa Renee Nickolaus
NPI 1922774751
Read from the NPPES registry on October 23, 2026.
Facts
- Status
- Active
- Credential
- RD, LD, IBCLC
- Type
- Individual
- Enumeration date
- 2021-08-20
- Last updated
- 2021-08-20
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Specialties
Licenses
- License 1
- L-124884
- License MO
- 2011041352
Location
- Practice location
- 1011 Scenic Oaks Ct
- City
- Imperial MO
- Postal code
- 63052-3457
- Phone
- (314) 363-6186
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
No exclusion found for this NPI in the OIG LEIE file dated October 9, 2026. Confirm on OIG's online search.
Nearby
Other NPIs in Imperial, MO. 128 records in the public file.
Public data from NPPES and CMS. Not a credentialing determination.
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