Basic Information
| Provider Information | |||||||||
| NPI: | 1992062541 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLTER-NITTA | ||||||||
| FirstName: | DIETLINDE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3411 WAYNE AVE | ||||||||
| Address2: | SUITE G | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104672509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189205922 | ||||||||
| FaxNumber: | 7189205202 | ||||||||
| Practice Location | |||||||||
| Address1: | 3400 BAINBRIDGE AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104672404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189205922 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2012 | ||||||||
| LastUpdateDate: | 04/20/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 000558 | NY | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.