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NPI Code Detail

MEDICARE: ERICA L PHELPS RD

MEDICARE:   ERICA L PHELPS  RD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1740242775
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICA L PHELPS RD
Provider Business Mailing Address
First Line : 15923 GROESBECK ST
Second Line :
City : GRAND HAVEN
State : MI
Zip : 49417-9470
Country : US
Telephone Number : 616-847-5357
Fax Number :
Provider Business Practice Location Address
First Line : 1309 SHELDON RD
Second Line :
City : GRAND HAVEN
State : MI
Zip : 49417-2404
Country : US
Telephone Number : 616-847-5357
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2006
Last Update Date : 07/08/2007

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Directions to “ ERICA L PHELPS RD” Practice Location

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