Basic Information
| Provider Information | |||||||||
| NPI: | 1427609452 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHOOLER | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | RAE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RDN, CDE | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MORAN | ||||||||
| OtherFirstName: | KELLY | ||||||||
| OtherMiddleName: | RAE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | RDN, CDE | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 23530 NORWOOD ST | ||||||||
| Address2: | |||||||||
| City: | OAK PARK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482372283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347483152 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 18544 W 8 MILE RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480754194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485691729 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2019 | ||||||||
| LastUpdateDate: | 09/20/2019 | ||||||||
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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 | 133V00000X | 1054573 | MI | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.