Provider Demographics
NPI:1689010274
Name:PREBLE, DEANA BETH (RD, CD)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:BETH
Last Name:PREBLE
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:DEANA
Other - Middle Name:BETH
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CD
Mailing Address - Street 1:3801 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3648
Mailing Address - Country:US
Mailing Address - Phone:608-244-4696
Mailing Address - Fax:608-244-5271
Practice Address - Street 1:3801 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3648
Practice Address - Country:US
Practice Address - Phone:608-244-4696
Practice Address - Fax:608-244-5271
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1543-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered