Provider Demographics
NPI:1750672853
Name:PFEIFFER, MARGARET (MS, RD, CLS)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:PFEIFFER
Suffix:
Gender:F
Credentials:MS, RD, CLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20485 COVENTRY DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-4053
Mailing Address - Country:US
Mailing Address - Phone:262-821-5563
Mailing Address - Fax:
Practice Address - Street 1:2600 N MAYFAIR RD STE 950
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1333
Practice Address - Country:US
Practice Address - Phone:414-456-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI312-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered