Provider Demographics
NPI:1619469590
Name:KUZNIAREK, JILL BERNADETTE (RDN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:BERNADETTE
Last Name:KUZNIAREK
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28623 LOCKERIDGE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-7039
Mailing Address - Country:US
Mailing Address - Phone:936-666-2818
Mailing Address - Fax:281-528-1112
Practice Address - Street 1:28623 LOCKERIDGE VIEW DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-7039
Practice Address - Country:US
Practice Address - Phone:936-666-2818
Practice Address - Fax:281-528-1112
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86050647133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered