Individual
ILZE KISELIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSRD LDN
Contact information
Practice address
5 NEPONSET ST, WORCESTER, MA 01606-2714
(508) 852-6175
(508) 595-2123
Mailing address
5 NEPONSET ST FL STREET12, WORCESTER, MA 01606-2714
(508) 852-6175
(508) 595-2123
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
632
MA
133V00000X
Registered Dietitian
632
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042472266
PRIVATE HEALTHCARE SYSTEM
—
01
—
67853
FALLON COMMUNITY HEALTH P
—
01
—
7001600
AETNA US HEALTHCARE
—
01
—
AA16844
HARVARD PILGRIM HEALTHCAR
—
01
—
LD0139
BLUE CROSS
—
Enumeration date
09/20/2006
Last updated
09/26/2018
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