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General NPI Number Information
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NPI Number | 1154497634
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Entity Type | Individual
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Provider Name | MICHELLE R. DIDIO RD
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Gender | Female
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 2945 HAZELWOOD ST
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City | MAPLEWOOD
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State | MN
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Zip | 55109-1241
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Country | US
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Telephone | 651-232-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 18002 JUDICIAL WAY N
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City | LAKEVILLE
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State | MN
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Zip | 55044-9381
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Country | US
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Telephone | 248-802-6028
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | 892296
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | 3503
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License Number State | MN
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