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General NPI Number Information
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NPI Number | 1689766156
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Entity Type | Individual
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Provider Name | MARILYNN C KSIAZEK MS RD CDE LDN
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Gender | Female
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 12/23/2010
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Provider Practice Location Address
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Address Line | 313 E DRINKER ST
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City | DUNMORE
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State | PA
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Zip | 18512-2408
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Country | US
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Telephone | 570-347-7127
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Fax | 570-347-1831
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Provider Business Mailing Address
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Address Line | 313 E DRINKER ST
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City | DUNMORE
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State | PA
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Zip | 18512-2408
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Country | US
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Telephone | 570-347-7127
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Fax | 570-347-1831
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DN000291
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License Number State | PA
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