Provider Demographics
NPI:1689004798
Name:NALIVKA, COURTNEY (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:NALIVKA
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 ERRECART BLVD
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-8333
Mailing Address - Country:US
Mailing Address - Phone:775-748-2094
Mailing Address - Fax:775-748-2096
Practice Address - Street 1:2001 ERRECART BLVD
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8333
Practice Address - Country:US
Practice Address - Phone:775-748-2094
Practice Address - Fax:775-748-2096
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV32072DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered