Provider Demographics
NPI:1003865684
Name:MORLEY, EVGENIIA (RD)
Entity Type:Individual
Prefix:
First Name:EVGENIIA
Middle Name:
Last Name:MORLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:EVGENIIA
Other - Middle Name:
Other - Last Name:BARANTCHOUK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CDR
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAROO
Mailing Address - State:MI
Mailing Address - Zip Code:49007
Mailing Address - Country:US
Mailing Address - Phone:269-341-6615
Mailing Address - Fax:269-341-7187
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:
Practice Address - City:KALAMAROO
Practice Address - State:MI
Practice Address - Zip Code:49007
Practice Address - Country:US
Practice Address - Phone:269-341-6615
Practice Address - Fax:269-341-7187
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI846622133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered