Provider Demographics
NPI:1053079244
Name:WOOD, DANIELLE (RDN)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 NEMOKE TRL APT 12
Mailing Address - Street 2:
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840-8638
Mailing Address - Country:US
Mailing Address - Phone:517-740-2939
Mailing Address - Fax:
Practice Address - Street 1:1843 N HAGADORN RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-2229
Practice Address - Country:US
Practice Address - Phone:517-332-5061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-04
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86147675133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered