Healthcare Provider Details

I. General information

NPI: 1689737363
Provider Name (Legal Business Name): LINDA LORRAINE KOCINSKI RD, CD, CNSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

2816 S 92ND ST
WEST ALLIS WI
53227-3418
US

V. Phone/Fax

Practice location:
  • Phone: 414-646-6695
  • Fax:
Mailing address:
  • Phone: 414-588-6845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number95-029
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: