Provider Demographics
NPI:1669477048
Name:WEYMILLER, BRIGITTE L (RD)
Entity Type:Individual
Prefix:
First Name:BRIGITTE
Middle Name:L
Last Name:WEYMILLER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:BRIGITTE
Other - Middle Name:L
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1836 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5429
Mailing Address - Country:US
Mailing Address - Phone:608-782-7300
Mailing Address - Fax:
Practice Address - Street 1:1830 STATE HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-7301
Practice Address - Country:US
Practice Address - Phone:563-382-2639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1772133V00000X
IA01350133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0026Medicare PIN