Individual
MRS. MARY ELISABETH QIBLAWI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D., C.D.
Contact information
Practice address
5900 S LAKE DR, CUDAHY, WI 53110-3171
(414) 489-4532
(414) 489-4217
Mailing address
5839 W EDGERTON AVE, GREENFIELD, WI 53220-4923
(414) 421-7440
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1082-029
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1082-029
STATE OF WI CREDENTIAL
WI
Enumeration date
01/03/2007
Last updated
08/03/2007
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