Provider Demographics
NPI:1568021921
Name:PACHNIUK, KARA GANSSLE (MS, CNS, CN)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:GANSSLE
Last Name:PACHNIUK
Suffix:
Gender:F
Credentials:MS, CNS, CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MEADOWOOD LN
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-1806
Mailing Address - Country:US
Mailing Address - Phone:203-913-6243
Mailing Address - Fax:
Practice Address - Street 1:15 MEADOWOOD LN
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-1806
Practice Address - Country:US
Practice Address - Phone:203-913-6243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001741133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist