Healthcare Provider Details

I. General information

NPI: 1942316716
Provider Name (Legal Business Name): BEVERLY KUZNICKI M.A., R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 ELLIOTT DR SUITE 201
YPSILANTI MI
48197-8633
US

IV. Provider business mailing address

5325 ELLIOTT DR SUITE 201
YPSILANTI MI
48197-8633
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-8000
  • Fax: 734-712-8010
Mailing address:
  • Phone: 734-712-8000
  • Fax: 734-712-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number00803637
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: