Most Relevant Information
Provider Data
| NPI Number: | 1003323692 |
| Provider Name: | JACKIE L HAVEL RD |
| Entity Type: | Individual |
| Taxonomy Code: | 133V00000X |
| Specialty: | Dietitian, Registered |
| License Number: | 2615-29 |
Most Important Dates
| Enumeration Date: | 01/04/2018 |
| Last Updated: | 01/04/2018 |
Provider Practice Location
525 AIRPORT DR
ONEIDA
WI
541559035
Practice Location Phone/Fax
| Phone: | 9208692711 |
| Fax: | 9208691782 |
Provider Mailing Location
PO BOX 365
ONEIDA
WI
541550365
Provider Mailing Phone/Fax
| Phone: | 9208692711 |
| Fax: | 9208691782 |