Provider Demographics
NPI:1083855217
Name:WOODRASKA, MEGAN JEAN (RD, LN)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:JEAN
Last Name:WOODRASKA
Suffix:
Gender:F
Credentials:RD, LN
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:JEAN
Other - Last Name:ISRAELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LN
Mailing Address - Street 1:1900 S. MARION RD.
Mailing Address - Street 2:HY-VEE
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106
Mailing Address - Country:US
Mailing Address - Phone:605-361-3442
Mailing Address - Fax:605-361-3396
Practice Address - Street 1:1900 S. MARION RD.
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106
Practice Address - Country:US
Practice Address - Phone:605-361-3442
Practice Address - Fax:605-361-3396
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0333133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered