Provider Demographics
NPI:1124873542
Name:TREFZGER, MADELYN (MS, RDN, LD)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:
Last Name:TREFZGER
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24515 ELLIOTT RD
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-9125
Mailing Address - Country:US
Mailing Address - Phone:419-980-9813
Mailing Address - Fax:
Practice Address - Street 1:4359 E ENON RD
Practice Address - Street 2:
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-9708
Practice Address - Country:US
Practice Address - Phone:937-206-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.10548133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered