Provider Demographics
NPI:1679306765
Name:FETTERHOFF, MIKAYLA KAEPPLER (PHD, RDN)
Entity type:Individual
Prefix:DR
First Name:MIKAYLA
Middle Name:KAEPPLER
Last Name:FETTERHOFF
Suffix:
Gender:F
Credentials:PHD, RDN
Other - Prefix:
Other - First Name:MIKAYLA
Other - Middle Name:
Other - Last Name:KAEPPLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, RDN
Mailing Address - Street 1:5002 AUTUMN LEAF LN APT 202
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-8654
Mailing Address - Country:US
Mailing Address - Phone:608-516-9949
Mailing Address - Fax:
Practice Address - Street 1:5002 AUTUMN LEAF LN APT 202
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-8654
Practice Address - Country:US
Practice Address - Phone:608-516-9949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI86291536133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered