Provider Demographics
NPI:1487637823
Name:KYSER, LINDA L (REG DIETICIAN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:KYSER
Suffix:
Gender:F
Credentials:REG DIETICIAN
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:L
Other - Last Name:STEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:REG DIETICIAN
Mailing Address - Street 1:3477 MOLITOR ROAD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701
Mailing Address - Country:US
Mailing Address - Phone:715-878-4343
Mailing Address - Fax:
Practice Address - Street 1:216 SUNSET PLACE
Practice Address - Street 2:MEMORIAL MEDICAL CENTER MEMORIAL HOSPITAL INC
Practice Address - City:NELLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456
Practice Address - Country:US
Practice Address - Phone:715-743-3101
Practice Address - Fax:715-743-6245
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI362761133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
0002Medicare ID - Type Unspecified