Provider Demographics
NPI:1407197650
Name:STROVINSKAS, NICOLE KROKO (DIETITIAN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:KROKO
Last Name:STROVINSKAS
Suffix:
Gender:F
Credentials:DIETITIAN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:KROKO
Other - Last Name:STROVINSKAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4646 N SHALLOWFORD RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6308
Mailing Address - Country:US
Mailing Address - Phone:770-676-6000
Mailing Address - Fax:770-392-9805
Practice Address - Street 1:4646 N SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6308
Practice Address - Country:US
Practice Address - Phone:770-676-6000
Practice Address - Fax:770-392-9805
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003472133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered