Healthcare Provider Details

I. General information

NPI: 1508356817
Provider Name (Legal Business Name): KELLY MACHMEIER RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 COMO AVE
SAINT PAUL MN
55108-1737
US

IV. Provider business mailing address

1007 WATER WHEEL DR
WAUNAKEE WI
53597-8905
US

V. Phone/Fax

Practice location:
  • Phone: 888-364-5977
  • Fax: 844-385-4630
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: