# TROLLWAY DIABETES INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Trollway Diabetes Care, Trollway Diabetes Care, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124774427
- **Authorized official:** JILL KRISTEN KIETZKE MSN, BC-ADM (PROGRAM COORDINATOR)
- **Authorized official phone:** (608) 512-8115

## Contact information

- **Practice address:** 640 S 1ST ST, MOUNT HOREB, WI 53572-3311
- **Practice address phone:** (608) 684-6686
- **Mailing address:** 640 S 1ST ST, MOUNT HOREB, WI 53572-3311
- **Mailing address phone:** (608) 512-8115

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174H00000X | Health Educator | — | NULL | Yes |
| 174H00000X | Health Educator | — | — | Yes |

## Other

- **Enumeration date:** 02/24/2022
- **Last updated:** 02/24/2022