Provider Demographics
NPI:1104493824
Name:KOHLER, DEBORAH JEAN (MS,RD,CD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JEAN
Last Name:KOHLER
Suffix:
Gender:F
Credentials:MS,RD,CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N4517 PRICE POLAR RD
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:WI
Mailing Address - Zip Code:54418-9663
Mailing Address - Country:US
Mailing Address - Phone:715-216-4456
Mailing Address - Fax:
Practice Address - Street 1:2251 N SHORE DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-6710
Practice Address - Country:US
Practice Address - Phone:715-361-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI706843133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered