Healthcare Provider Details

I. General information

NPI: 1619469590
Provider Name (Legal Business Name): JILL BERNADETTE KUZNIAREK RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28623 LOCKERIDGE VIEW DR
SPRING TX
77386-7039
US

IV. Provider business mailing address

28623 LOCKERIDGE VIEW DR
SPRING TX
77386-7039
US

V. Phone/Fax

Practice location:
  • Phone: 936-666-2818
  • Fax: 281-528-1112
Mailing address:
  • Phone: 936-666-2818
  • Fax: 281-528-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86050647
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: