Healthcare Provider Details

I. General information

NPI: 1629141049
Provider Name (Legal Business Name): NANETTE MICHELLE CAMERON REGISTERED DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11994 HYNE RD
BRIGHTON MI
48114-9234
US

IV. Provider business mailing address

28289 HOOVER RD
WARREN MI
48093-5436
US

V. Phone/Fax

Practice location:
  • Phone: 810-333-2872
  • Fax:
Mailing address:
  • Phone: 810-333-2872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number833070
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: