Provider Demographics
NPI:1851131098
Name:PETERLIN, CIERRA (RD)
Entity type:Individual
Prefix:
First Name:CIERRA
Middle Name:
Last Name:PETERLIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 JENIFER ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-4814
Mailing Address - Country:US
Mailing Address - Phone:267-500-5987
Mailing Address - Fax:
Practice Address - Street 1:1140 JENIFER ST APT 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-4814
Practice Address - Country:US
Practice Address - Phone:267-500-5987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered