Healthcare Provider Details

I. General information

NPI: 1811227937
Provider Name (Legal Business Name): MS. MICHELLE KICHERER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 ARLINGTON DR
SAN LEANDRO CA
94578-1132
US

IV. Provider business mailing address

2125 BRYCE DR
MARTINEZ CA
94553-4901
US

V. Phone/Fax

Practice location:
  • Phone: 510-481-1222
  • Fax:
Mailing address:
  • Phone: 510-481-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: