Provider Demographics
NPI:1760807259
Name:NITKA, NATHAN (RD, CD)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:NITKA
Suffix:
Gender:M
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:WI
Mailing Address - Zip Code:53015-1413
Mailing Address - Country:US
Mailing Address - Phone:920-693-5600
Mailing Address - Fax:
Practice Address - Street 1:1205 NORTH AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:WI
Practice Address - Zip Code:53015-1413
Practice Address - Country:US
Practice Address - Phone:920-693-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2677-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered