Healthcare Provider Details

I. General information

NPI: 1770946212
Provider Name (Legal Business Name): LELA NIEMETZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 1/2 BROOKS ST
ONEIDA NY
13421-2402
US

IV. Provider business mailing address

108 BRIDGE ST
CLEVELAND NY
13042-3144
US

V. Phone/Fax

Practice location:
  • Phone: 315-651-1377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number48008147
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number48008147
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number48008147
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: