Healthcare Provider Details

I. General information

NPI: 1275915597
Provider Name (Legal Business Name): KARI MIZGALSKI RD, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 CRANBERRY BLVD
WESTON WI
54476-5213
US

IV. Provider business mailing address

3501 CRANBERRY BLVD
WESTON WI
54476-5213
US

V. Phone/Fax

Practice location:
  • Phone: 715-393-1000
  • Fax: 715-393-1469
Mailing address:
  • Phone: 715-393-1000
  • Fax: 715-393-1469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2252-29
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: