Healthcare Provider Details

I. General information

NPI: 1245942796
Provider Name (Legal Business Name): MADELEINE BOYLE RDN, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

2752 N BARTLETT AVE APT 6
MILWAUKEE WI
53211-3500
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-6885
  • Fax:
Mailing address:
  • Phone: 260-307-3373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3736-29
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: