Provider Demographics
NPI:1306938196
Name:KOMLODI, DIANE MARY (RD CD)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARY
Last Name:KOMLODI
Suffix:
Gender:F
Credentials:RD CD
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:MARY
Other - Last Name:CERWINKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD CD
Mailing Address - Street 1:1208 CAVALIER DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-6806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5000 WEST NATIONAL AVENUE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53295
Practice Address - Country:US
Practice Address - Phone:414-384-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered