Doctor Name: | MARY RADER |
NPI Number: | 1023281359 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 611 N Mayfair Rd Wauwatosa, WI - 532264248 |
Business Phone Number: | 4142582255 |
Business Fax Number: | |
Mailing Address: | 611 N Mayfair Rd, WAUWATOSA |
State: | WI |
Postal Code: | 532264248 |
Phone Number: | 4142582255 |
Fax Number: | |
NPI Enumeration Date: | 04/08/2008 |
NPI Last Update Date: | 04/08/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133NN1002X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Nutritionist |
Taxonomy Specialization: | Nutrition, Education |
Taxonomy Definition: |