Provider Demographics
NPI:1124682109
Name:BENDA, KARRIE RENEE (MS,RD)
Entity type:Individual
Prefix:
First Name:KARRIE
Middle Name:RENEE
Last Name:BENDA
Suffix:
Gender:F
Credentials:MS,RD
Other - Prefix:
Other - First Name:KARRIE
Other - Middle Name:RENEE
Other - Last Name:GARBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:420 DEWEY ST
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-4714
Mailing Address - Country:US
Mailing Address - Phone:715-422-9364
Mailing Address - Fax:
Practice Address - Street 1:420 DEWEY ST
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-4714
Practice Address - Country:US
Practice Address - Phone:715-422-9364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered