Individual
MARY A GEORG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CD
Contact information
Practice address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8573
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1405
WI
Other
Enumeration date
02/26/2007
Last updated
06/10/2013
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