Provider Demographics
NPI:1710315692
Name:WIEKRYKAS, DEVON (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:WIEKRYKAS
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-1406
Mailing Address - Country:US
Mailing Address - Phone:717-763-1798
Mailing Address - Fax:
Practice Address - Street 1:1017 MUMMA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WORMLEYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17043-1145
Practice Address - Country:US
Practice Address - Phone:717-763-1798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005209133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered