Provider Demographics
NPI:1861981995
Name:KRCHMA, KAREN DIANE (RDN CD)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:DIANE
Last Name:KRCHMA
Suffix:
Gender:F
Credentials:RDN CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11713 N EUGENE AVE
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-2111
Mailing Address - Country:US
Mailing Address - Phone:414-315-8800
Mailing Address - Fax:
Practice Address - Street 1:216 GREEN BAY RD STE 103
Practice Address - Street 2:
Practice Address - City:THIENSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53092-1625
Practice Address - Country:US
Practice Address - Phone:414-315-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI801900133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered