Provider Demographics
NPI:1720123334
Name:DAVIE, JANICE O (RD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:O
Last Name:DAVIE
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 1:3658 W CYPRESS LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8782
Mailing Address - Country:US
Mailing Address - Phone:414-364-3816
Mailing Address - Fax:
Practice Address - Street 1:7095 S BALLPARK DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-6908
Practice Address - Country:US
Practice Address - Phone:414-224-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI167133V00000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI012502120Medicare ID - Type Unspecified