Provider Demographics
NPI:1649658477
Name:KOLISON, VALERIA
Entity type:Individual
Prefix:
First Name:VALERIA
Middle Name:
Last Name:KOLISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VALERIA
Other - Middle Name:
Other - Last Name:PURNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CD
Mailing Address - Street 1:5710 SANDHILL DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5249
Mailing Address - Country:US
Mailing Address - Phone:615-415-2789
Mailing Address - Fax:608-203-5461
Practice Address - Street 1:5710 SANDHILL DR
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-5249
Practice Address - Country:US
Practice Address - Phone:615-415-2789
Practice Address - Fax:608-203-5461
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2393-29133V00000X
TN1049133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered