Healthcare Provider Details

I. General information

NPI: 1710124615
Provider Name (Legal Business Name): ALICE D WEBBER R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICE D KRAEMER

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15600 19 MILE RD
CLINTON TOWNSHIP MI
48038-3502
US

IV. Provider business mailing address

176 PLEASANT MANOR DR
WATERFORD MI
48327-4302
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-8700
  • Fax:
Mailing address:
  • Phone: 810-404-3739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number808541
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: