Provider Demographics
NPI:1083187272
Name:HARTUNG, KATIE JO (MS, RD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:JO
Last Name:HARTUNG
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:NORRISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1220 3RD AVE W
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:WI
Mailing Address - Zip Code:54736-1600
Mailing Address - Country:US
Mailing Address - Phone:715-672-4211
Mailing Address - Fax:715-672-5989
Practice Address - Street 1:1220 3RD AVE W
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:WI
Practice Address - Zip Code:54736-1600
Practice Address - Country:US
Practice Address - Phone:715-672-4211
Practice Address - Fax:715-672-5989
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI86024510133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered