Provider Demographics
NPI:1518478429
Name:MIELNIK, KRISTA (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:MIELNIK
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 1:1289 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-2515
Mailing Address - Country:US
Mailing Address - Phone:216-445-3378
Mailing Address - Fax:216-445-4356
Practice Address - Street 1:2049 E 100TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-2104
Practice Address - Country:US
Practice Address - Phone:216-444-3046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.7985133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered