Provider Demographics
NPI:1922636208
Name:KRAWCZYK, KATHRYN (MA, RDN, CDN, CNSC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:KRAWCZYK
Suffix:
Gender:F
Credentials:MA, RDN, CDN, CNSC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:MUTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1534 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13207-1011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:750 E ADAMS ST RM C1088
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2306
Practice Address - Country:US
Practice Address - Phone:315-464-3607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008836133VN1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology