Provider Demographics
NPI:1720639792
Name:NOSEK, CLARA ISABELLE (RDN)
Entity Type:Individual
Prefix:MRS
First Name:CLARA ISABELLE
Middle Name:
Last Name:NOSEK
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 BUSTI AVE APT 405
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-2100
Mailing Address - Country:US
Mailing Address - Phone:818-285-9335
Mailing Address - Fax:
Practice Address - Street 1:960 BUSTI AVE APT 405
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-2100
Practice Address - Country:US
Practice Address - Phone:818-285-9335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-21
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009544133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered