Individual
KELLEY ANASTASIA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, CD, CNSC
Contact information
Practice address
750 UNIVERSITY ROW, ROOM 353, MADISON, WI 53705-1311
(608) 890-5005
Mailing address
750 UNIVERSITY ROW, ROOM 353, MADISON, WI 53705-1311
(608) 890-5005
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2740-29
WI
Other
Enumeration date
07/11/2014
Last updated
04/12/2016
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