Shelly Renee Wildenberg, MS, RD, CD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

00965973 Issued in WI

Practice address

1700 W Stout St
Rice Lake, WI 54868-5000

Phone

(715) 236-6139

NPI assigned

Jan 20, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Shelly Renee Falls Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1295481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1568767655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 W STOUT ST",
            "city": "RICE LAKE",
            "state": "WI",
            "postal_code": "548685000",
            "telephone_number": "715-236-6139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 W STOUT ST",
            "city": "RICE LAKE",
            "state": "WI",
            "postal_code": "548685000",
            "telephone_number": "715-236-6139"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2661 County Highway I",
            "address_2": "St. Josephs Hospital",
            "address_purpose": "LOCATION",
            "city": "Chippewa Falls",
            "state": "WI",
            "postal_code": "54729",
            "country_code": "US",
            "telephone_number": "715-717-7382",
            "fax_number": "715-717-7629",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILDENBERG",
        "first_name": "SHELLY",
        "middle_name": "RENEE",
        "name_prefix": "Ms.",
        "credential": "MS, RD, CD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-20",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "WI",
            "license": "00965973",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELLY",
            "last_name": "FALLS",
            "middle_name": "RENEE",
            "credential": "RD, CDE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Registered Dietitian in Rice Lake, WI
• Providers in Rice Lake, WI by specialty
• Registered Dietitian in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.