Provider Demographics
NPI:1639295249
Name:KWIATKOWSKI, LINDA L (RD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:KWIATKOWSKI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 E.ARAPAHOE ROAD
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2463
Mailing Address - Country:US
Mailing Address - Phone:303-850-2155
Mailing Address - Fax:303-850-2037
Practice Address - Street 1:5555 E.ARAPAHOE ROAD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122
Practice Address - Country:US
Practice Address - Phone:303-850-2155
Practice Address - Fax:303-850-2037
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC1639295249Medicare PIN