Provider Demographics
NPI:1881734564
Name:KULAKOWSKI, KAREN PATRICIA (RD, LDN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:PATRICIA
Last Name:KULAKOWSKI
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-1821
Mailing Address - Country:US
Mailing Address - Phone:413-478-0723
Mailing Address - Fax:
Practice Address - Street 1:18 MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01151-1821
Practice Address - Country:US
Practice Address - Phone:413-478-0723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA446133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMT0552Medicare ID - Type Unspecified