Provider Demographics
NPI:1679871578
Name:LOWE, MARJORIE THERESE (RD, CSG, CD)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:THERESE
Last Name:LOWE
Suffix:
Gender:F
Credentials:RD, CSG, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11431 W BELMAR DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-1170
Mailing Address - Country:US
Mailing Address - Phone:414-617-8636
Mailing Address - Fax:888-417-3327
Practice Address - Street 1:11431 W BELMAR DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-1170
Practice Address - Country:US
Practice Address - Phone:414-617-8636
Practice Address - Fax:888-417-3327
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1136-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered