Provider Demographics
NPI:1659028231
Name:KOLLAK, TAYLOR NICOLE (RDN)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:NICOLE
Last Name:KOLLAK
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 1:11201 COPPERLINE RD E
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712-8875
Mailing Address - Country:US
Mailing Address - Phone:618-302-0368
Mailing Address - Fax:
Practice Address - Street 1:1033 E MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-7149
Practice Address - Country:US
Practice Address - Phone:888-492-8722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered