Provider Demographics
NPI:1639866155
Name:HUMMEL, ALLIE (RD, CD)
Entity Type:Individual
Prefix:MRS
First Name:ALLIE
Middle Name:
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W BRADLEY RD APT 232C
Mailing Address - Street 2:
Mailing Address - City:FOX POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53217-2633
Mailing Address - Country:US
Mailing Address - Phone:920-475-7337
Mailing Address - Fax:
Practice Address - Street 1:500 W BRADLEY RD APT 232C
Practice Address - Street 2:
Practice Address - City:FOX POINT
Practice Address - State:WI
Practice Address - Zip Code:53217-2633
Practice Address - Country:US
Practice Address - Phone:920-475-7337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5156-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered