Provider Demographics
NPI:1568566776
Name:MCINTYRE, PAULA K (RD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:K
Last Name:MCINTYRE
Suffix:
Gender:F
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:W3311 COUNTY ROAD C
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-9420
Mailing Address - Country:US
Mailing Address - Phone:715-573-5678
Mailing Address - Fax:
Practice Address - Street 1:W3311 COUNTY ROAD C
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-9420
Practice Address - Country:US
Practice Address - Phone:715-573-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI923133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered