Provider Demographics
NPI:1801576129
Name:MORGAN-BATHKE, MARIA (RD, PHD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:MORGAN-BATHKE
Suffix:
Gender:F
Credentials:RD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 20TH ST S
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5005
Mailing Address - Country:US
Mailing Address - Phone:507-261-1861
Mailing Address - Fax:
Practice Address - Street 1:724 20TH ST S
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-5005
Practice Address - Country:US
Practice Address - Phone:507-261-1861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1011913133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered