Petershack, Kim L

Petershack, Kim L is an individual health care provider with primary practice located at 1313 Fish Hatchery Rd , Madison WI 53715-1911. She recently has only one registered license in Dietary & Nutritional Service Providers / Dietitian, Registered, which is considered as her primary health care specialty. Petershack, Kim L can be contacted via phone (608) 252-8000.

Contact Information

Primary practice address
1313 Fish Hatchery Rd Madison WI 53715-1911
Phone: (608) 252-8000
Fax: (608) 283-7192
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X 15-029 Wisconsin

Profile Details

NPI number 1346206323
LBN Legal business name Petershack, Kim L
Credentials Clinical Dietitian (CD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 26th, 2006
Last updated Jan 23rd, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346206323 NPPES
Wisconsin Other 1948 DEAN HEALTH INSURANCE

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