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General NPI Number Information
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NPI Number | 1427653500
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Entity Type | Individual
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Provider Name | KELLEY MICHELLE ENCINAS RD
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Gender | Female
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Dates
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Enumeration Date | 12/04/2020
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Last Update Date | 12/04/2020
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Provider Practice Location Address
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Address Line | 1011 N 8TH ST
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City | SHEBOYGAN
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State | WI
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Zip | 53081-4006
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Country | US
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Telephone | 920-459-6411
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Fax |
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Provider Business Mailing Address
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Address Line | 7126 TAMARACK CT
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City | MEQUON
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State | WI
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Zip | 53092-8517
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Country | US
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Telephone | 818-825-3191
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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 |
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License Number State |
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