Provider Demographics
NPI:1770069015
Name:NITOWSKI, LAURA J (RDN, LDN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:NITOWSKI
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S PRAIRIE AVE APT 2205
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3425
Mailing Address - Country:US
Mailing Address - Phone:267-535-0524
Mailing Address - Fax:
Practice Address - Street 1:1201 S PRAIRIE AVE APT 2205
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-3425
Practice Address - Country:US
Practice Address - Phone:267-535-0524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.007199133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered