Provider Demographics
NPI:1336985233
Name:SWIENCKI, ALEXIS GRACE (RD, LDN)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:GRACE
Last Name:SWIENCKI
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 WEAVER AVE
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1370
Mailing Address - Country:US
Mailing Address - Phone:814-979-1374
Mailing Address - Fax:
Practice Address - Street 1:58 WEAVER AVE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1370
Practice Address - Country:US
Practice Address - Phone:814-979-1374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN007896133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered