Provider Demographics
NPI:1063761187
Name:CEBULLA, VALERIE MAY (RD)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:MAY
Last Name:CEBULLA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7327 W. BLUEMOUND ROAD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53213-3636
Mailing Address - Country:US
Mailing Address - Phone:414-902-2481
Mailing Address - Fax:414-383-9346
Practice Address - Street 1:1555 S. LAYTON BLVD
Practice Address - Street 2:GARDEN 20
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208
Practice Address - Country:US
Practice Address - Phone:414-902-2481
Practice Address - Fax:414-383-9346
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIR800844133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered