Provider Demographics
NPI:1376923599
Name:NOWAKOWSKI, KATHERINE (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:NOWAKOWSKI
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 QUINCY DR
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-2643
Mailing Address - Country:US
Mailing Address - Phone:703-989-0093
Mailing Address - Fax:
Practice Address - Street 1:115 QUINCY DR
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-2643
Practice Address - Country:US
Practice Address - Phone:703-989-0093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1060959133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered