Provider Demographics
NPI:1831939586
Name:MILLIGAN, KAITLYN (RDN LDN, CLS)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:MILLIGAN
Suffix:
Gender:F
Credentials:RDN LDN, CLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 AVENUE OF THE CITIES
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-4544
Mailing Address - Country:US
Mailing Address - Phone:515-695-3291
Mailing Address - Fax:
Practice Address - Street 1:4218 AVENUE OF THE CITIES
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-4544
Practice Address - Country:US
Practice Address - Phone:515-695-3291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA86066407133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered