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General NPI Number Information
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NPI Number | 1124585120
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Entity Type | Individual
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Provider Name | VANESSA MIHALICK RD
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Gender | Female
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Dates
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Enumeration Date | 02/26/2019
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Last Update Date | 02/26/2019
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Provider Practice Location Address
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Address Line | 400 HOBART ST
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City | CADILLAC
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State | MI
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Zip | 49601-2331
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Country | US
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Telephone | 231-876-6633
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Fax |
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Provider Business Mailing Address
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Address Line | 13307 W SHORE DR
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City | HOUGHTON LAKE
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State | MI
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Zip | 48629-8656
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Country | US
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Telephone | 248-496-0074
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86051661
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License Number State | MI
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