Basic Information
| Provider Information | |||||||||
| NPI: | 1053079244 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | DANIELLE | ||||||||
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| Credential: | RDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1745 NEMOKE TRL APT 12 | ||||||||
| Address2: | |||||||||
| City: | HASLETT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488408638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177402939 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1843 N HAGADORN RD | ||||||||
| Address2: | |||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488232229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173325061 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2021 | ||||||||
| LastUpdateDate: | 12/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 86147675 | MI | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.