Provider Demographics
NPI:1528586781
Name:DUKARSKI, KELLY J (RDCSR)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:DUKARSKI
Suffix:
Gender:F
Credentials:RDCSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 W SHARLEAR DR
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-1264
Mailing Address - Country:US
Mailing Address - Phone:989-225-3722
Mailing Address - Fax:
Practice Address - Street 1:4 COLUMBUS AVE STE 240
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6472
Practice Address - Country:US
Practice Address - Phone:888-569-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist