Provider Demographics
NPI:1053842518
Name:PUSTILNIK, JOANNA (MS RDN LDN CDCES)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:
Last Name:PUSTILNIK
Suffix:
Gender:F
Credentials:MS RDN LDN CDCES
Other - Prefix:MISS
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2134 S NELSON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-5410
Mailing Address - Country:US
Mailing Address - Phone:804-787-4431
Mailing Address - Fax:
Practice Address - Street 1:2134 S NELSON ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-5410
Practice Address - Country:US
Practice Address - Phone:804-787-4431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-25
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1032609133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered