Provider Demographics
NPI:1720331457
Name:TAMARACK NUTRITION & WELLNESS CONSULTING
Entity Type:Organization
Organization Name:TAMARACK NUTRITION & WELLNESS CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:MARTEN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:715-495-5157
Mailing Address - Street 1:130 S. BARSTOW STREET
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701
Mailing Address - Country:US
Mailing Address - Phone:715-495-5157
Mailing Address - Fax:
Practice Address - Street 1:130 S BARSTOW ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3691
Practice Address - Country:US
Practice Address - Phone:715-495-5157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1499-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty