Provider Demographics
NPI:1205015849
Name:PETERMAN, KIMBERLY ANN (RD/LD,CDE)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:PETERMAN
Suffix:
Gender:F
Credentials:RD/LD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-4790
Mailing Address - Country:US
Mailing Address - Phone:563-589-2324
Mailing Address - Fax:563-557-2878
Practice Address - Street 1:1560 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-4790
Practice Address - Country:US
Practice Address - Phone:563-589-2324
Practice Address - Fax:563-557-2878
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01299133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered