1134321284 NPI number — MRS. CARYN A PAWLAK MS, RD, CD

Table of content: MRS. CARYN A PAWLAK MS, RD, CD (NPI 1134321284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134321284 NPI number — MRS. CARYN A PAWLAK MS, RD, CD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAWLAK
Provider First Name:
CARYN
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, CD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOSSART
Provider Other First Name:
CARYN
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, RD, CD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134321284
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2301 SUN VALLEY DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
DELAFIELD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53018-2318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-646-4162
Provider Business Mailing Address Fax Number:
262-646-2498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 DELAFIELD ST
Provider Second Line Business Practice Location Address:
SUITE 327
Provider Business Practice Location Address City Name:
WAUKESHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53188-3417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-524-1024
Provider Business Practice Location Address Fax Number:
262-524-8767
Provider Enumeration Date:
06/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133VN1005X , with the licence number:  872431 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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