Provider Demographics
NPI:1437608304
Name:MOHR, BENJAMIN (RD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:MOHR
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W5757 STRUBLE RD
Mailing Address - Street 2:
Mailing Address - City:NEILLSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54456-6527
Mailing Address - Country:US
Mailing Address - Phone:715-937-3420
Mailing Address - Fax:
Practice Address - Street 1:216 SUNSET PL
Practice Address - Street 2:
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456-1706
Practice Address - Country:US
Practice Address - Phone:715-937-3420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered