Provider Demographics
NPI:1295375277
Name:DOBROT, ALISE (RDN, LDN, LMT)
Entity Type:Individual
Prefix:
First Name:ALISE
Middle Name:
Last Name:DOBROT
Suffix:
Gender:F
Credentials:RDN, LDN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3081 PARKER PASS
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-8510
Mailing Address - Country:US
Mailing Address - Phone:608-658-5027
Mailing Address - Fax:
Practice Address - Street 1:778 LOIS DR
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-1100
Practice Address - Country:US
Practice Address - Phone:608-658-5027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004989133V00000X
WI4690-146225700000X
MI7501010282225700000X
WI3029-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty