Provider Demographics
NPI:1598586133
Name:KONIECZNY, NATALIE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:KONIECZNY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:DISIMONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN, LDN, CSSD
Mailing Address - Street 1:1900 THAMES DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-2770
Mailing Address - Country:US
Mailing Address - Phone:215-688-3491
Mailing Address - Fax:
Practice Address - Street 1:4401 LITTLE RD STE 550
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-5621
Practice Address - Country:US
Practice Address - Phone:215-688-3491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT91123133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered