Healthcare Provider Details

I. General information

NPI: 1003865684
Provider Name (Legal Business Name): EVGENIIA MORLEY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVGENIIA BARANTCHOUK CDR

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 JOHN ST
KALAMAROO MI
49007
US

IV. Provider business mailing address

601 JOHN ST
KALAMAROO MI
49007
US

V. Phone/Fax

Practice location:
  • Phone: 269-341-6615
  • Fax: 269-341-7187
Mailing address:
  • Phone: 269-341-6615
  • Fax: 269-341-7187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number846622
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: