Healthcare Provider Details

I. General information

NPI: 1598305476
Provider Name (Legal Business Name): KAREN MARIE WOYAK RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 AMUNDSON ST
WISCONSIN RAPIDS WI
54494-3241
US

IV. Provider business mailing address

2940 AMUNDSON ST
WISCONSIN RAPIDS WI
54494-3241
US

V. Phone/Fax

Practice location:
  • Phone: 715-421-3055
  • Fax:
Mailing address:
  • Phone: 715-421-3055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number3295-29
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: