Provider Demographics
NPI:1508100132
Name:KOCZARSKI, MOLLY JEAN (MOLLY KOCZARSKI, RDN)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:JEAN
Last Name:KOCZARSKI
Suffix:
Gender:F
Credentials:MOLLY KOCZARSKI, RDN
Other - Prefix:MISS
Other - First Name:MOLLY
Other - Middle Name:JEAN
Other - Last Name:MAXFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOLLY MAXFIELD, RD
Mailing Address - Street 1:9040 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:690 BARNES BLVD
Practice Address - Street 2:
Practice Address - City:JOINT BASE LEWIS MCCHORD
Practice Address - State:WA
Practice Address - Zip Code:98438-1303
Practice Address - Country:US
Practice Address - Phone:360-580-5423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60083621133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered