Provider Demographics
NPI:1376684811
Name:WOLOSZYN, KIMBERLY J (MS, RD, CDN)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:J
Last Name:WOLOSZYN
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 CROOKED ST
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-9526
Mailing Address - Country:US
Mailing Address - Phone:518-399-9750
Mailing Address - Fax:
Practice Address - Street 1:72 CROOKED ST
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-9526
Practice Address - Country:US
Practice Address - Phone:518-399-9750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered