Healthcare Provider Details

I. General information

NPI: 1861981995
Provider Name (Legal Business Name): KAREN DIANE KRCHMA RDN CD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 GREEN BAY RD STE 103
THIENSVILLE WI
53092-1625
US

IV. Provider business mailing address

11713 N EUGENE AVE
MEQUON WI
53092-2111
US

V. Phone/Fax

Practice location:
  • Phone: 414-315-8800
  • Fax:
Mailing address:
  • Phone: 414-315-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number801900
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: