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Individual

GENDA SUE FREEMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RD, CD

Contact information

Practice address
112 E 5TH AVE, ANTIGO, WI 54409-2710
(715) 623-9873
Mailing address
112 E 5TH AVE, ANTIGO, WI 54409-2710
(715) 623-9873

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2375-29
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2375-29
STATE OF WISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES
WI
01
713749
COMMISSION ON DIETETIC REGISTRATION
Enumeration date
09/28/2022
Last updated
09/28/2022
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