Basic Information
| Provider Information | |||||||||
| NPI: | 1609474840 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOLLETT | ||||||||
| FirstName: | MAI SING | ||||||||
| MiddleName: | |||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2320 LARUE LN | ||||||||
| Address2: | |||||||||
| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 543135797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9205623688 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3014 ERIE AVE | ||||||||
| Address2: | |||||||||
| City: | SHEBOYGAN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530813696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204593028 | ||||||||
| FaxNumber: | 9204537052 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2020 | ||||||||
| LastUpdateDate: | 10/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.