Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 0119061 | NY |
NPI | 1255665626 |
---|---|
Provider Name | Dr. Kristen Marie Latona-Brzezinski |
First Address | Williamsville, NY 14221-7021 |
Second Address | Williamsville, NY 14221-7021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2009 |
Last Update Date | 28/02/2020 |