Provider Demographics
NPI:1679728687
Name:GOREE, SANDY Z (RD)
Entity Type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:Z
Last Name:GOREE
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 1:33788 BOUSKA RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU CHIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53821-8504
Mailing Address - Country:US
Mailing Address - Phone:608-326-4815
Mailing Address - Fax:
Practice Address - Street 1:33788 BOUSKA RD
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821-8504
Practice Address - Country:US
Practice Address - Phone:608-326-4815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI267-29133V00000X
IA1227133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered