Healthcare Provider Details

I. General information

NPI: 1154937753
Provider Name (Legal Business Name): COLLEEN WOJDYLA MFN, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: COLLEEN LINEHAN

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31424 IROQUOIS DR
WARREN MI
48088-7009
US

IV. Provider business mailing address

31424 IROQUOIS DR
WARREN MI
48088-7009
US

V. Phone/Fax

Practice location:
  • Phone: 330-635-7126
  • Fax:
Mailing address:
  • Phone: 330-635-7126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: