Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Nicole Wake, MS, RD

Individual provider Registered Dietitian · NPI 1073990362

Nicole Wake, MS, RD is a Registered Dietitian in Norwich, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2015
What do these letters mean?
MS — Master of Science
A graduate science degree.
RD — Registered Dietitian
A credentialed nutrition professional.

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Practice location Address checks out

179 N Broad St
Norwich, NY 13815-1019
Phone: (607) 337-4812
Fax: (607) 337-4198
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Registered Dietitian (primary) Taxonomy 133V00000X · Licence 1019080 (NY)

Record details

NPI number1073990362
Entity typeIndividual (Type 1)
GenderFemale
Credentials MS , RD
Sole proprietorYes
NPI enumeratedMay 6, 2015
Last updated in NPPESJuly 1, 2020
Certification dateJuly 1, 2020
Mailing address145 Co Rd 32a, Norwich, NY 13815

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