Provider Demographics
NPI:1891294013
Name:THIELKE WEBER, KARI LYNN (RDN, CEDRD-S, CD)
Entity Type:Individual
Prefix:MS
First Name:KARI
Middle Name:LYNN
Last Name:THIELKE WEBER
Suffix:
Gender:F
Credentials:RDN, CEDRD-S, CD
Other - Prefix:MS
Other - First Name:KARI
Other - Middle Name:LYNN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:705 VILLAGE GREEN WAY UNIT 405
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53090-2500
Mailing Address - Country:US
Mailing Address - Phone:262-707-3691
Mailing Address - Fax:
Practice Address - Street 1:301 N MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3319
Practice Address - Country:US
Practice Address - Phone:262-707-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI870281133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered