Provider Demographics
NPI:1144016882
Name:KOSZEWSKI, WANDA MARIE (PHD, RD, LD)
Entity type:Individual
Prefix:DR
First Name:WANDA
Middle Name:MARIE
Last Name:KOSZEWSKI
Suffix:
Gender:F
Credentials:PHD, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 TRADITIONS DR APT 415
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-8555
Mailing Address - Country:US
Mailing Address - Phone:803-979-0358
Mailing Address - Fax:
Practice Address - Street 1:1125 TRADITIONS DR APT 415
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-8555
Practice Address - Country:US
Practice Address - Phone:803-979-0358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1400133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered