Provider Demographics
NPI:1801414347
Name:WEIS, MONICA LYNNE (RD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:LYNNE
Last Name:WEIS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:LYNNE
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W310N1140 BUNKER HILL TRL
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-2716
Mailing Address - Country:US
Mailing Address - Phone:262-894-0803
Mailing Address - Fax:
Practice Address - Street 1:5000 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53295-0001
Practice Address - Country:US
Practice Address - Phone:414-384-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2927-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered