Provider Demographics
NPI:1013558063
Name:GEILE, ERIKA S (DIETICIAN, RD)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:S
Last Name:GEILE
Suffix:
Gender:F
Credentials:DIETICIAN, RD
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:S
Other - Last Name:NIELSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:330 E BELTLINE AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-1267
Mailing Address - Country:US
Mailing Address - Phone:616-752-6235
Mailing Address - Fax:616-752-6324
Practice Address - Street 1:330 E BELTLINE AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-1267
Practice Address - Country:US
Practice Address - Phone:616-752-6235
Practice Address - Fax:616-752-6324
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI974648133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1013558063Medicaid