MEDICARE: ARLEEN DENISE HARRIS BLYTHE R.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133NN1002X	Nutrition Education Nutritionist	R357296	MI

General Provider Information

NPI Number	:	1619008109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARLEEN DENISE HARRIS BLYTHE R.D.

Provider Business Mailing Address
First Line	:	1151 TAYLOR STREET, 2-C WING
Second Line	:	DETROIT HEALTH DEPARTMENT - HERMAN KIEFER HEALTH COMPLE
City	:	DETROIT
State	:	MI
Zip	:	48202-1732
Country	:	US
Telephone Number	:	313-876-4558
Fax Number	:	313-876-4645

Provider Business Practice Location Address
First Line	:	DETROIT HEALTH DEPT - HERMAN KIEFER HEALTH COMPLEX
Second Line	:	1151 TAYLOR STREET, WING , 2C
City	:	DETRIOT
State	:	MI
Zip	:	48202-1732
Country	:	US
Telephone Number	:	313-876-4558
Fax Number	:	313-876-4645

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/08/2007

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