Basic Information
| Provider Information | |||||||||
| NPI: | 1740243203 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEDEL | ||||||||
| FirstName: | NAOMI | ||||||||
| MiddleName: | Y | ||||||||
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| Credential: | CD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 752 N HIGH POINT RD | ||||||||
| Address2: | DEAN MEDICAL CENTER | ||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537172236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088244000 | ||||||||
| FaxNumber: | 6088244910 | ||||||||
| Practice Location | |||||||||
| Address1: | 752 N HIGH POINT RD | ||||||||
| Address2: | DEAN MEDICAL CENTER | ||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537172236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088244000 | ||||||||
| FaxNumber: | 6088244910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 385-029 | WI | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 3660 | 01 | WI | DEAN HEALTH PLAN | OTHER |