Courtney Iwanicki, MS, RD, CSP

Primary specialty

Pediatric Nutrition Registered DietitianTaxonomy code 133VN1004X

Practice address

13733 Allen Rd
Clinton, MI 49236-9653

Phone

(269) 591-2464

NPI assigned

Dec 17, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639699200000",
    "number": "1891454815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13733 ALLEN RD",
            "city": "CLINTON",
            "state": "MI",
            "postal_code": "492369653",
            "telephone_number": "269-591-2464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13733 ALLEN RD",
            "city": "CLINTON",
            "state": "MI",
            "postal_code": "492369653",
            "telephone_number": "269-591-2464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IWANICKI",
        "first_name": "COURTNEY",
        "credential": "MS, RD, CSP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-17",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.gethealthie.com/",
            "affiliation": "N",
            "endpointDescription": "Dietitian charting platform that is HIPPA Compliant",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "13733 Allen Rd",
            "city": "Clinton",
            "state": "MI",
            "country_code": "US",
            "postal_code": "492369653",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Pediatric Nutrition Registered Dietitian in Clinton, MI
• Providers in Clinton, MI by specialty
• Pediatric Nutrition Registered Dietitian in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.