NPIMap

Organization Active NPI

Mary Rader Clinical Dietitian LLC

  • Health Service Clinic/Center
  • Wauwatosa, WI
National Provider Identifier
1225293079
Registry record updated Sep 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
827029 Issued in WI
Legal business name
MARY RADER CLINICAL DIETITIAN LLC
Practice address
611 N Mayfair Rd
Wauwatosa, WI 53226-4248
Phone
(414) 258-2255
NPI assigned
Jul 22, 2008
Last updated
Sep 12, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mary Rader, C.D.NPI 1023281359
Title
Certified Dietitian
Phone
(414) 258-2255

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X 827029 WI Primary

Addresses

Primary practice location

611 N Mayfair Rd
Wauwatosa, WI 53226-4248

Mailing address

611 N Mayfair Rd
Wauwatosa, WI 53226-4248
Phone (414) 258-2255

National Provider Directory

National Provider Directory

Locations

611 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 258-2255

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221177600000",
    "number": "1225293079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 N MAYFAIR RD",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532264248",
            "telephone_number": "414-258-2255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 N MAYFAIR RD",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532264248",
            "telephone_number": "414-258-2255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY RADER CLINICAL DIETITIAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-22",
        "last_updated": "2008-09-12",
        "status": "A",
        "authorized_official_last_name": "RADER",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "CERTIFIED DIETITIAN",
        "authorized_official_telephone_number": "414-258-2255",
        "authorized_official_credential": "C.D."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "WI",
            "license": "827029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.