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General NPI Number Information
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NPI Number | 1124463559
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Entity Type | Individual
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Provider Name | SHANNON NICOLE PIERONEK M.S., R.D., C.D.
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Gender | Female
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 5015 W BURLEIGH ST
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City | MILWAUKEE
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State | WI
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Zip | 53210-1662
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Country | US
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Telephone | 414-874-4116
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Fax | 414-874-4507
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Provider Business Mailing Address
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Address Line | N53W21948 REDBUD LN
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-6275
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 00977230
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License Number State | WI
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