Provider Demographics
NPI:1457802597
Name:MALENSKY, NIKKI
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:MALENSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 SIPSEY FORK RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:AL
Mailing Address - Zip Code:35552-2024
Mailing Address - Country:US
Mailing Address - Phone:636-439-0184
Mailing Address - Fax:
Practice Address - Street 1:1035 SIPSEY FORK RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:AL
Practice Address - Zip Code:35552-2024
Practice Address - Country:US
Practice Address - Phone:636-439-0184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist