Provider Demographics
NPI:1588949028
Name:TENGLER, THERESA MARIE (RD)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:MARIE
Last Name:TENGLER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
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Mailing Address - Street 1:2415 MADISON ST
Mailing Address - Street 2:ENTER YOUR SECOND ADDRESS
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-4627
Mailing Address - Country:US
Mailing Address - Phone:262-894-0330
Mailing Address - Fax:
Practice Address - Street 1:2725 HILLSIDE DR STE A
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2165
Practice Address - Country:US
Practice Address - Phone:262-646-2123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI01044099133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI01044099OtherADA