Provider Demographics
NPI:1255774048
Name:JURKOWSKI-ERWIN, VIRGINIA (RD)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:
Last Name:JURKOWSKI-ERWIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 REDWOOD BLVD
Mailing Address - Street 2:SUITE NUMBER 100
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-4110
Mailing Address - Country:US
Mailing Address - Phone:415-895-5636
Mailing Address - Fax:415-895-5634
Practice Address - Street 1:7100 REDWOOD BLVD
Practice Address - Street 2:SUITE NUMBER 100
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-4110
Practice Address - Country:US
Practice Address - Phone:415-895-5636
Practice Address - Fax:415-895-5634
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 5579133V00000X
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered