Provider Demographics
NPI:1679705222
Name:HOULE, LEAH MARIE (RD)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:MARIE
Last Name:HOULE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4933 STANWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5456
Mailing Address - Country:US
Mailing Address - Phone:231-215-5125
Mailing Address - Fax:
Practice Address - Street 1:433 SEMINOLE RD STE 204
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-3743
Practice Address - Country:US
Practice Address - Phone:231-215-5125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI27-0549579OtherEIN