Provider Demographics
NPI:1306885215
Name:NIEMCZURA, PRZEMYSLAW KONRAD (RD)
Entity type:Individual
Prefix:MR
First Name:PRZEMYSLAW
Middle Name:KONRAD
Last Name:NIEMCZURA
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 41 BOX 2563
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09464
Mailing Address - Country:US
Mailing Address - Phone:01144163-852-8124
Mailing Address - Fax:01144163-852-8022
Practice Address - Street 1:48 MEDICAL GROUP
Practice Address - Street 2:UNIT 5210
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09461
Practice Address - Country:US
Practice Address - Phone:01144163-852-8124
Practice Address - Fax:01144163-852-8022
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL886882133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered