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General NPI Number Information
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NPI Number | 1629892989
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Entity Type | Individual
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Provider Name | MAKENNA DILLER RDN
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Gender | Female
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 4150 KALAMAZOO AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-3605
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Country | US
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Telephone | 616-913-2006
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Fax |
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Provider Business Mailing Address
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Address Line | 344 PAGE ST NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-5056
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Country | US
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Telephone | 419-890-8042
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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 | 86177030
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License Number State | MI
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