Provider Demographics
NPI:1295053940
Name:KAZAKIS, NANCY J (RDLD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:KAZAKIS
Suffix:
Gender:F
Credentials:RDLD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:J
Other - Last Name:SOWD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDLD
Mailing Address - Street 1:875 8TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-8503
Mailing Address - Country:US
Mailing Address - Phone:330-837-6878
Mailing Address - Fax:330-830-6962
Practice Address - Street 1:875 8TH ST NE
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-8503
Practice Address - Country:US
Practice Address - Phone:330-837-6878
Practice Address - Fax:330-830-6962
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD 471133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered