Individual Healthcare Provider
Nicole Kristina Derse, CNC
Provider's NPPES record last updated: October 18, 2018
Overview
- Entity Type
- Individual Healthcare Provider
- NPI
- 1073089934
- Primary Specialty
- Nutritionist
- Practice Location
- Appleton, Wisconsin
- Sole Proprietor
- No
Federal Screening
NPISignal checked this NPI against federal exclusion sources. Results below are based on the NPI number itself — an identifier match, not a name match.
List of Excluded Individuals/Entities (LEIE)
HHS Office of Inspector General
No potential match was identified in NPISignal's indexed List of Excluded Individuals/Entities (LEIE) records as of 2026-09-10.
- Source data
- September 10, 2026
- Records indexed
- 84,001
- Screened
- Sep 17, 2026, 11:36 PM UTC
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
SAM.gov Exclusions
U.S. General Services Administration
SAM.gov Exclusions was not checked.
SAM.gov screening is not configured on this deployment. No SAM check has been performed.
- Screened
- Not checked
This is an NPI-based check only. NPISignal does not publish name-based exclusion matches on a provider profile. A shared or similar name is a lead that requires human review, not an identification, and this page is not the place to make one. Run a name-based screening below to see potential matches with the reasons for each.
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
Searches OIG LEIE and SAM.gov by name and reviews every potential match.
Specialties & Taxonomies
- Primary
Nutritionist
Dietary & Nutritional Service Providers
A specialist in adapting and applying food and nutrient knowledge to the solution of food and nutritional problems, the control of disease, and the promotion of health. Nutritionists perform research, instruct groups and individuals about nutritional requirements, and assist people in developing meal patterns that meet their nutritional needs; (2) A nutritionist is someone who has completed undergraduate and/or graduate training in the discipline of nutrition without necessarily meeting the academic and experience requirements to qualify for the Registered Dietitian designation.
Taxonomy code 133N00000X
Provider-Reported License Information
- Nutritionist (Wisconsin)
- 12D577516
Practice Locations
Practice Location
308 E Glendale Ave
Appleton, Wisconsin 54911-2907
Phone: (920) 322-5115
Record Information
- Enumeration Date
- October 18, 2018
- Provider's NPPES Record Last Updated
- October 18, 2018
- NPISignal NPPES Dataset
- August 2026
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