Provider Demographics
NPI:1386046860
Name:KRAUTKRAMER, ASHLEY M (CD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:KRAUTKRAMER
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:M
Other - Last Name:POEPKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CD
Mailing Address - Street 1:PO BOX 2759
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54912-2759
Mailing Address - Country:US
Mailing Address - Phone:920-831-5077
Mailing Address - Fax:920-831-5093
Practice Address - Street 1:1818 N MEADE ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-3454
Practice Address - Country:US
Practice Address - Phone:920-831-5077
Practice Address - Fax:920-831-5093
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2771133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered