Provider Demographics
NPI:1467993360
Name:BRKOVIC, NIKOLINA (RD)
Entity Type:Individual
Prefix:
First Name:NIKOLINA
Middle Name:
Last Name:BRKOVIC
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 1:1010 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-1500
Mailing Address - Country:US
Mailing Address - Phone:608-741-2459
Mailing Address - Fax:608-741-2438
Practice Address - Street 1:1010 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-1500
Practice Address - Country:US
Practice Address - Phone:608-741-2459
Practice Address - Fax:608-741-2438
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3102-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered