Basic Information
| Provider Information | |||||||||
| NPI: | 1700980885 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROMANN | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | RD CD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | PENNEY | ||||||||
| OtherFirstName: | KATHRYN | ||||||||
| OtherMiddleName: | H | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3000 WESTHILL DR | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | WAUSAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544013795 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 143 S GIBSON ST | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544511622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7157482121 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2006 | ||||||||
| 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 | 1088 | WI | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.