Provider Demographics
NPI:1942251194
Name:WISK, JUDITH MARY (RD LDN)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:MARY
Last Name:WISK
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22 MILL ST
Mailing Address - Street 2:SUITE N
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-3237
Mailing Address - Country:US
Mailing Address - Phone:844-328-9473
Mailing Address - Fax:724-437-1571
Practice Address - Street 1:22 MILL ST
Practice Address - Street 2:SUITE N
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3237
Practice Address - Country:US
Practice Address - Phone:844-328-9473
Practice Address - Fax:724-437-1571
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN 002028133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist