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General NPI Number Information
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NPI Number | 1689498115
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Entity Type | Individual
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Provider Name | AMANDA ZAGRODNIK CNS
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Gender | Female
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 10341 W VERA AVE
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City | MILWAUKEE
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State | WI
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Zip | 53224-4441
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Country | US
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Telephone | 262-215-6788
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1843
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City | BROOKFIELD
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State | WI
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Zip | 53008-1843
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Country | US
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Telephone | 262-215-6788
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 18998
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License Number State | WI
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