Healthcare Provider Details

I. General information

NPI: 1508027830
Provider Name (Legal Business Name): IRENE ELIZABETH FRANOWICZ REGISTERED DIETICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BARCLAY AVE NE STE 304
GRAND RAPIDS MI
49503-2527
US

IV. Provider business mailing address

100 MICHIGAN ST NE MC 059
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-2160
  • Fax:
Mailing address:
  • Phone: 616-391-1876
  • Fax: 616-391-3892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number836473
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: