Provider Demographics
NPI:1427217520
Name:GOTOWKO, CAROLYN ELIZABETH (RD,CDN)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:ELIZABETH
Last Name:GOTOWKO
Suffix:
Gender:F
Credentials: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 DALE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-4202
Mailing Address - Country:US
Mailing Address - Phone:716-694-2224
Mailing Address - Fax:
Practice Address - Street 1:72 DALE DR
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-4202
Practice Address - Country:US
Practice Address - Phone:716-694-2224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL362976133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered