Provider Demographics
NPI:1003588294
Name:SWIECICKI, ISABELLA MARGARET (RD)
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:MARGARET
Last Name:SWIECICKI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6340 DOWD FOREST DR APT 206
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-7158
Mailing Address - Country:US
Mailing Address - Phone:248-953-9712
Mailing Address - Fax:
Practice Address - Street 1:6340 DOWD FOREST DR APT 206
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-7158
Practice Address - Country:US
Practice Address - Phone:248-953-9712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL006575133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86210048OtherRD NUMBER
NCL006575OtherRD LICENSE