Provider Demographics
NPI:1205394426
Name:MAIDMENT, KATELIN MARIE (RD)
Entity Type:Individual
Prefix:
First Name:KATELIN
Middle Name:MARIE
Last Name:MAIDMENT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KATELIN
Other - Middle Name:MARIE
Other - Last Name:BRANDSTATTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:27515 160TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW AUBURN
Mailing Address - State:WI
Mailing Address - Zip Code:54757-5247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27515 160TH ST
Practice Address - Street 2:
Practice Address - City:NEW AUBURN
Practice Address - State:WI
Practice Address - Zip Code:54757-5247
Practice Address - Country:US
Practice Address - Phone:715-402-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered