Jerilyn R Abba
Individual provider Active NPI Registered Dietitian · Ripon, WI
NPI 1487725172 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1487725172
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 1004-029 (WI)
- Practice address
- 933 Newbury St
Ripon, WI 54971-1730 - Phone
- (920) 748-9495
- NPI assigned
- Nov 13, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1004-029 | WI | MD | Registered Dietitian |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 1004-029 | WI | Yes |
Addresses
Primary practice location
933 Newbury St
Ripon, WI 54971-1730
Mailing address
933 Newbury St
Ripon, WI 54971-1730
Phone (920) 748-9495
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1004-029 | Other | WI | STATE CERTIFICATION NUMBE |
Other providers in Ripon, WI
- Advanced Womens Healthcare Center, LLC
- Agnesian Healthcare Inc
- Agnesian Healthcare Inc
- Linda Ahrens
- Joshua Anderson
All providers in Ripon, WI · Registered Dietitian in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.