Provider Demographics
NPI:1942967831
Name:KRUEGER, DEBRA K (RDN, CD, IBCLC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:RDN, CD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-5274
Mailing Address - Country:US
Mailing Address - Phone:715-218-5859
Mailing Address - Fax:
Practice Address - Street 1:1712 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-5274
Practice Address - Country:US
Practice Address - Phone:715-218-5859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1943-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered