Individual
JEAN KOSTAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD
Contact information
Practice address
263 FARMINGTON AVE, FARMINGTON, CT 06030-6220
(860) 679-4477
(860) 679-4474
Mailing address
263 FARMINGTON AVE, PROVIDER ENROLLMENT, FARMINGTON, CT 06030-2212
(860) 679-7503
(860) 679-1610
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
000312
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000312
CERTIFICATION
CT
Enumeration date
01/04/2007
Last updated
09/26/2022
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