Provider Demographics
NPI:1124774427
Name:TROLLWAY DIABETES INC.
Entity type:Organization
Organization Name:TROLLWAY DIABETES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:KRISTEN
Authorized Official - Last Name:KIETZKE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, BC-ADM
Authorized Official - Phone:608-512-8115
Mailing Address - Street 1:640 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-3311
Mailing Address - Country:US
Mailing Address - Phone:608-512-8115
Mailing Address - Fax:
Practice Address - Street 1:640 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572-3311
Practice Address - Country:US
Practice Address - Phone:608-684-6686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty