Basic Information
| Provider Information | |||||||||
| NPI: | 1083622864 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NAUMOFF | ||||||||
| FirstName: | JO ANN | ||||||||
| MiddleName: | BOYANA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | R.D., M.A, | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4815 TERNES ST | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481263083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135848505 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4646 JOHN R ST | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482011916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135764565 | ||||||||
| FaxNumber: | 3135761041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133VN1005X | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Renal |
No ID Information.