Provider Demographics
NPI:1457028854
Name:DEAN, ABIGAIL JEAN (MS, RD, CD)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:JEAN
Last Name:DEAN
Suffix:
Gender:F
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:JEAN
Other - Last Name:FENSKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, CD
Mailing Address - Street 1:5579 WHISPERING PINES DR
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-9753
Mailing Address - Country:US
Mailing Address - Phone:715-651-9228
Mailing Address - Fax:
Practice Address - Street 1:201 PRAIRIE RUN
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-1174
Practice Address - Country:US
Practice Address - Phone:715-651-9228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI86076989133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered