Provider Demographics
NPI:1255142402
Name:ZUNKER, KATIE ELIZABETH (RDN, CD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ELIZABETH
Last Name:ZUNKER
Suffix:
Gender:F
Credentials:RDN, CD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:ELIZABETH
Other - Last Name:MACCOUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, CD
Mailing Address - Street 1:1065 NUTMEG DRIVE
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115
Mailing Address - Country:US
Mailing Address - Phone:920-265-5621
Mailing Address - Fax:
Practice Address - Street 1:2395 S ONEIDA ST STE 100
Practice Address - Street 2:
Practice Address - City:ASHWAUBENON
Practice Address - State:WI
Practice Address - Zip Code:54304-5266
Practice Address - Country:US
Practice Address - Phone:515-695-3205
Practice Address - Fax:833-719-1241
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3595-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered