Provider Demographics
NPI:1760906564
Name:WIESEN, KAREN (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:WIESEN
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-9800
Mailing Address - Country:US
Mailing Address - Phone:570-271-7820
Mailing Address - Fax:570-271-7805
Practice Address - Street 1:100 N. ACADEMY AVE
Practice Address - Street 2:MC: 15-09
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-9800
Practice Address - Country:US
Practice Address - Phone:570-271-7820
Practice Address - Fax:570-271-7805
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005102133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered