Provider Demographics
NPI:1023121266
Name:MARKUSON, ANN ELIZABETH (RD,CD,CDE)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:ELIZABETH
Last Name:MARKUSON
Suffix:
Gender:F
Credentials:RD,CD,CDE
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:ELIZABETH
Other - Last Name:BUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD,CD
Mailing Address - Street 1:6200 W BLUEMOUND RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53213-4145
Mailing Address - Country:US
Mailing Address - Phone:414-771-5600
Mailing Address - Fax:414-476-9988
Practice Address - Street 1:6200 W BLUEMOUND RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53213-4145
Practice Address - Country:US
Practice Address - Phone:414-771-5600
Practice Address - Fax:414-476-9988
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI711528133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered