Provider Demographics
NPI:1619675147
Name:ROHDE, MEGAN JANEEN (RD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:JANEEN
Last Name:ROHDE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:JANEEN
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5905 PENINSULA WAY
Mailing Address - Street 2:
Mailing Address - City:MCFARLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53558-9128
Mailing Address - Country:US
Mailing Address - Phone:608-698-9605
Mailing Address - Fax:
Practice Address - Street 1:451 JUNCTION RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2656
Practice Address - Country:US
Practice Address - Phone:608-890-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2079-79133V00000X
954519133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered