Provider Demographics
NPI:1235016296
Name:WOLANZYK, KAYLA MARIE (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:WOLANZYK
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 MATTHIOLA DR
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-3230
Mailing Address - Country:US
Mailing Address - Phone:231-881-8223
Mailing Address - Fax:
Practice Address - Street 1:617 MATTHIOLA DR
Practice Address - Street 2:
Practice Address - City:WENDELL
Practice Address - State:NC
Practice Address - Zip Code:27591-3230
Practice Address - Country:US
Practice Address - Phone:231-881-8223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL008795133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered