MEDICARE: MRS. KATISHA SCHNAE NIELSEN R.D

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	133VN1004X	Pediatric Nutrition Registered Dietitian
2	133NN1002X	Nutrition Education Nutritionist
3	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1073786067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATISHA SCHNAE NIELSEN R.D

Provider Business Mailing Address
First Line	:	1345 BIG HORN TRL
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60188-9075
Country	:	US
Telephone Number	:	630-550-2331
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 W PINEHURST CIR APT 202
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-3629
Country	:	US
Telephone Number	:	630-550-2331
Fax Number	:	630-517-8942

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

Provider Enumeration Date	:	04/10/2008
Last Update Date	:	03/13/2020

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