Provider Demographics
NPI:1740789502
Name:SWANSON, KIMBERLY KAYE (MBA, RDN, CD)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:KAYE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MBA, RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 RACINE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4762
Mailing Address - Country:US
Mailing Address - Phone:608-347-6115
Mailing Address - Fax:
Practice Address - Street 1:34 SCHROEDER CT STE 230
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2528
Practice Address - Country:US
Practice Address - Phone:608-347-7794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11429133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered