Provider Demographics
NPI:1447521067
Name:HAYWOOD, WAHNETA M (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:WAHNETA
Middle Name:M
Last Name:HAYWOOD
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2722 BADGER AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50647-9774
Mailing Address - Country:US
Mailing Address - Phone:319-987-2345
Mailing Address - Fax:
Practice Address - Street 1:312 9TH ST SW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2929
Practice Address - Country:US
Practice Address - Phone:319-352-4120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00150133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA00150OtherLICENSE, DIETETICS
401087OtherREGISTERED DIETITIAN