Provider Demographics
NPI:1215297114
Name:WOODLAND, KAREN ELAINA (RD, CD, CDE)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ELAINA
Last Name:WOODLAND
Suffix:
Gender:F
Credentials:RD, CD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N4688 COUNTY ROAD Q
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-9556
Mailing Address - Country:US
Mailing Address - Phone:608-295-6787
Mailing Address - Fax:
Practice Address - Street 1:N4688 COUNTY ROAD Q
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-9556
Practice Address - Country:US
Practice Address - Phone:608-295-6787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1396-029133V00000X
IL164.004903133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered