Healthcare Provider Details

I. General information

NPI: 1639396336
Provider Name (Legal Business Name): LINDA DIANE STEFONEK R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 HOSPITAL RD
NEW RICHMOND WI
54017-1449
US

IV. Provider business mailing address

872 140TH AVE
NEW RICHMOND WI
54017-6942
US

V. Phone/Fax

Practice location:
  • Phone: 715-243-7202
  • Fax: 715-243-7222
Mailing address:
  • Phone: 715-246-5231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number915-029
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: