Provider Demographics
NPI:1497273163
Name:BOECK, MARIA L (RDN,CDE)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:BOECK
Suffix:
Gender:F
Credentials:RDN,CDE
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:L
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, CD
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:WI
Mailing Address - Zip Code:54155-0365
Mailing Address - Country:US
Mailing Address - Phone:920-869-4910
Mailing Address - Fax:920-869-4909
Practice Address - Street 1:525 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:WI
Practice Address - Zip Code:54155-9035
Practice Address - Country:US
Practice Address - Phone:920-869-4829
Practice Address - Fax:920-869-4909
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3134-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI86082189OtherCOMMISSION ON DIETETIC REGISTRATION
32200409OtherCERTIFIED DIABETES EDUCATOR