Provider Demographics
NPI:1598018764
Name:NUTRIKISS INC
Entity Type:Organization
Organization Name:NUTRIKISS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RZEZNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-597-7974
Mailing Address - Street 1:2155 CAMBERLEY PL
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-1894
Mailing Address - Country:US
Mailing Address - Phone:770-597-7974
Mailing Address - Fax:
Practice Address - Street 1:1275 SHILOH RD NW STE 3030
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7186
Practice Address - Country:US
Practice Address - Phone:770-597-7974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 133V00000X
GALD003649133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty