Healthcare Provider Details

I. General information

NPI: 1245359538
Provider Name (Legal Business Name): LAURA ANN OLEJNICZAK RD,CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 10TH ST NUTRITION SERVICES
NIAGARA FALLS NY
14301-1813
US

IV. Provider business mailing address

369 SHETLAND DR
WILLIAMSVILLE NY
14221-3921
US

V. Phone/Fax

Practice location:
  • Phone: 716-278-4363
  • Fax: 716-278-4266
Mailing address:
  • Phone: 716-633-8936
  • Fax: 716-278-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number003124
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: