Provider Demographics
NPI:1073786067
Name:NIELSEN, KATISHA SCHNAE (RD)
Entity Type:Individual
Prefix:MRS
First Name:KATISHA
Middle Name:SCHNAE
Last Name:NIELSEN
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 1:1345 BIG HORN TRL
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-9075
Mailing Address - Country:US
Mailing Address - Phone:630-550-2331
Mailing Address - Fax:
Practice Address - Street 1:10 W PINEHURST CIR APT 202
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-3629
Practice Address - Country:US
Practice Address - Phone:630-550-2331
Practice Address - Fax:630-517-8942
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education