Provider Demographics
NPI:1508296765
Name:HARNISCH, MICHELLE (MS, RD, CD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HARNISCH
Suffix:
Gender:
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:SWADER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, RD, CD
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1102 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1708
Practice Address - Country:US
Practice Address - Phone:608-263-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1015696133V00000X
WI2227-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered