Healthcare Provider Details

I. General information

NPI: 1548980840
Provider Name (Legal Business Name): APIRAMY JEEVANANTHAN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 S PARK ST
MADISON WI
53713-1916
US

IV. Provider business mailing address

2901 W BELTLINE HWY STE 120
MADISON WI
53713-4231
US

V. Phone/Fax

Practice location:
  • Phone: 608-443-5480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number3737
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: