Provider Demographics
NPI:1033259163
Name:PELKEY, MICHELLE (RD)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:PELKEY
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 1:523 N 3RD ST
Mailing Address - Street 2:ST. JOSEPH'S MEDICAL CENTER
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3054
Mailing Address - Country:US
Mailing Address - Phone:218-828-7623
Mailing Address - Fax:218-828-7579
Practice Address - Street 1:523 N 3RD ST
Practice Address - Street 2:ST. JOSEPH'S MEDICAL CENTER
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3054
Practice Address - Country:US
Practice Address - Phone:218-828-7623
Practice Address - Fax:218-828-7579
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1737133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered