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NPI Code Detail

MEDICARE: SUSAN M MCILRAITH RD

MEDICARE: SUSAN M MCILRAITH RD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian486WI

General Provider Information

NPI Number : 1205822541
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN M MCILRAITH RD
Provider Business Mailing Address
First Line : 411 LINCOLN ST
Second Line :
City : NEENAH
State : WI
Zip : 54956-2753
Country : US
Telephone Number : 920-727-4395
Fax Number :
Provider Business Practice Location Address
First Line : 411 LINCOLN ST
Second Line :
City : NEENAH
State : WI
Zip : 54956-2753
Country : US
Telephone Number : 920-727-4395
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2005
Last Update Date : 07/08/2007

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Directions to “ SUSAN M MCILRAITH RD” Practice Location

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