MEDICARE: MRS. JOANNA PUSTILNIK MS RDN LDN CDCES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1032609

General Provider Information

NPI Number	:	1053842518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOANNA PUSTILNIK MS RDN LDN CDCES

Provider Business Mailing Address
First Line	:	2134 S NELSON ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-5410
Country	:	US
Telephone Number	:	804-787-4431
Fax Number	:

Provider Business Practice Location Address
First Line	:	2134 S NELSON ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-5410
Country	:	US
Telephone Number	:	804-787-4431
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2017
Last Update Date	:	12/11/2023

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