Provider Demographics
NPI:1013398726
Name:SZANIAWSKI, NICOLE (RDN, CD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SZANIAWSKI
Suffix:
Gender:F
Credentials:RDN, CD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:GEGELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16535 W BLUEMOUND RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5906
Mailing Address - Country:US
Mailing Address - Phone:262-789-1191
Mailing Address - Fax:262-821-6180
Practice Address - Street 1:16535 W BLUEMOUND RD STE 200
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5906
Practice Address - Country:US
Practice Address - Phone:262-789-1191
Practice Address - Fax:262-821-6180
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI244729133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered