Provider Demographics
NPI:1245359538
Name:OLEJNICZAK, LAURA ANN (RD,CDN)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:OLEJNICZAK
Suffix:
Gender:F
Credentials:RD,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 SHETLAND DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3921
Mailing Address - Country:US
Mailing Address - Phone:716-633-8936
Mailing Address - Fax:716-278-4266
Practice Address - Street 1:621 10TH ST
Practice Address - Street 2:NUTRITION SERVICES
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1813
Practice Address - Country:US
Practice Address - Phone:716-278-4363
Practice Address - Fax:716-278-4266
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003124133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY039958Medicare ID - Type Unspecified