Provider Demographics
NPI:1134321284
Name:PAWLAK, CARYN A (MS, RD, CD)
Entity Type:Individual
Prefix:MRS
First Name:CARYN
Middle Name:A
Last Name:PAWLAK
Suffix:
Gender:F
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:CARYN
Other - Middle Name:A
Other - Last Name:JOSSART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, CD
Mailing Address - Street 1:2301 SUN VALLEY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-2318
Mailing Address - Country:US
Mailing Address - Phone:262-646-4162
Mailing Address - Fax:262-646-2498
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:SUITE 327
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3417
Practice Address - Country:US
Practice Address - Phone:262-524-1024
Practice Address - Fax:262-524-8767
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI872431133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal