Provider Demographics
NPI:1649781725
Name:MALINOWSKI, BONITA L (MS RD CSR LDN)
Entity type:Individual
Prefix:
First Name:BONITA
Middle Name:L
Last Name:MALINOWSKI
Suffix:
Gender:F
Credentials:MS RD CSR LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 W COURT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3692
Mailing Address - Country:US
Mailing Address - Phone:815-937-3077
Mailing Address - Fax:815-937-8743
Practice Address - Street 1:500 W COURT ST
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3661
Practice Address - Country:US
Practice Address - Phone:815-937-3077
Practice Address - Fax:815-937-8743
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal