Provider Demographics
NPI:1417537044
Name:MILMEISTER, MADISON (MS, MED, RDN)
Entity Type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:
Last Name:MILMEISTER
Suffix:
Gender:F
Credentials:MS, MED, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4616 ROMA CT
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6791
Mailing Address - Country:US
Mailing Address - Phone:305-978-6618
Mailing Address - Fax:
Practice Address - Street 1:4616 ROMA CT
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6791
Practice Address - Country:US
Practice Address - Phone:305-978-6618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY998072133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered