Individual
MS. MARILYNN C KSIAZEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS RD CDE LDN
Contact information
Practice address
313 E DRINKER ST, DUNMORE, PA 18512-2408
(570) 347-7127
(570) 347-1831
Mailing address
313 E DRINKER ST, DUNMORE, PA 18512-2408
(570) 347-7127
(570) 347-1831
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DN000291
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0077712630002
—
PA
01
—
0538494
AETNA
—
01
—
816479
FIRST PRIORITY HEALTH
PA
01
—
KS1789844
HIGHMARK BS
PA
Enumeration date
09/29/2006
Last updated
12/23/2010
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