Healthcare Provider Details

I. General information

NPI: 1972412989
Provider Name (Legal Business Name): AVERY MURDZEK RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 S 27TH ST
FRANKLIN WI
53132-7209
US

IV. Provider business mailing address

10101 S 27TH ST
FRANKLIN WI
53132-7209
US

V. Phone/Fax

Practice location:
  • Phone: 414-259-7585
  • Fax: 262-687-6344
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86416387
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: