Healthcare Provider Details

I. General information

NPI: 1619008109
Provider Name (Legal Business Name): ARLEEN DENISE HARRIS BLYTHE R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DETROIT HEALTH DEPT - HERMAN KIEFER HEALTH COMPLEX 1151 TAYLOR STREET, WING , 2C
DETRIOT MI
48202-1732
US

IV. Provider business mailing address

1151 TAYLOR STREET, 2-C WING DETROIT HEALTH DEPARTMENT - HERMAN KIEFER HEALTH COMPLE
DETROIT MI
48202-1732
US

V. Phone/Fax

Practice location:
  • Phone: 313-876-4558
  • Fax: 313-876-4645
Mailing address:
  • Phone: 313-876-4558
  • Fax: 313-876-4645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberR357296
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: