Provider Demographics
NPI:1811761828
Name:NYANZI, ABIGAIL LOUISE (RD)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:LOUISE
Last Name:NYANZI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:LOUISE
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1060 GREEN MOUNTAIN CT APT E
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-6414
Mailing Address - Country:US
Mailing Address - Phone:636-222-7883
Mailing Address - Fax:
Practice Address - Street 1:915 N GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-1621
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023036942133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered