Provider Demographics
NPI:1730821653
Name:DEGRAVE, ARYN (MS, RDN, CLC, CD)
Entity type:Individual
Prefix:
First Name:ARYN
Middle Name:
Last Name:DEGRAVE
Suffix:
Gender:F
Credentials:MS, RDN, CLC, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 N DICKINSON ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-2414
Mailing Address - Country:US
Mailing Address - Phone:414-587-5947
Mailing Address - Fax:
Practice Address - Street 1:675 S WHITNEY WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1034
Practice Address - Country:US
Practice Address - Phone:608-277-6735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN008585133V00000X
WI3389-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered