MEDICARE: NIKKI MALENSKY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1457802597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKKI MALENSKY

Provider Business Mailing Address
First Line	:	1035 SIPSEY FORK RD
Second Line	:
City	:	DETROIT
State	:	AL
Zip	:	35552-2024
Country	:	US
Telephone Number	:	636-439-0184
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 SIPSEY FORK RD
Second Line	:
City	:	DETROIT
State	:	AL
Zip	:	35552-2024
Country	:	US
Telephone Number	:	636-439-0184
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2016
Last Update Date	:	10/24/2016

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Directions to “ NIKKI MALENSKY ” Practice Location

Language	Start Address	Practice Location

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