Healthcare Provider Details

I. General information

NPI: 1427675750
Provider Name (Legal Business Name): GIDETTE MICHELENE OBILA RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICH ZWINGER RD

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1449 W SOUTHERN AVE
TEMPE AZ
85282-4446
US

IV. Provider business mailing address

1449 W SOUTHERN AVE
TEMPE AZ
85282-4446
US

V. Phone/Fax

Practice location:
  • Phone: 480-967-6360
  • Fax: 480-967-6184
Mailing address:
  • Phone: 480-967-6360
  • Fax: 480-967-6184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86167580
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: