1891294013 NPI number — MS. KARI LYNN THIELKE WEBER RDN, CEDRD-S, CD

Table of content: MS. KARI LYNN THIELKE WEBER RDN, CEDRD-S, CD (NPI 1891294013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891294013 NPI number — MS. KARI LYNN THIELKE WEBER RDN, CEDRD-S, CD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THIELKE WEBER
Provider First Name:
KARI
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RDN, CEDRD-S, CD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
KARI
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891294013
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
705 VILLAGE GREEN WAY UNIT 405
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST BEND
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53090-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-707-3691
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 N MAIN ST STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST BEND
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53095-3319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-707-3691
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2018

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: 133V00000X , with the licence number:  870281 , 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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