Provider Demographics
NPI:1265879183
Name:KASUN-LAMB, STEFANIE LYN (RD)
Entity type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:LYN
Last Name:KASUN-LAMB
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3365 FIEBRANTZ DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-3364
Mailing Address - Country:US
Mailing Address - Phone:715-572-7863
Mailing Address - Fax:
Practice Address - Street 1:3365 FIEBRANTZ DR
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-3364
Practice Address - Country:US
Practice Address - Phone:715-572-7863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-01
Last Update Date:2013-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2262-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered