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General NPI Number Information
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NPI Number | 1427612639
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Entity Type | Organization
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Legal Business Name | GO EAT WISE
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Dates
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Enumeration Date | 04/24/2019
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 17340 W 12 MILE RD STE 103
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City | SOUTHFIELD
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State | MI
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Zip | 48076-6322
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Country | US
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Telephone | 248-234-4212
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Fax | 248-856-4697
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Provider Business Mailing Address
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Address Line | 17340 W 12 MILE RD STE 103
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City | SOUTHFIELD
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State | MI
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Zip | 48076-6322
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Country | US
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Telephone | 248-234-4212
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Fax | 248-856-4697
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | JENNIFER D ELKINS
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Credential | RD
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Telephone | 248-519-3960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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