Provider Demographics
NPI:1154497634
Name:DIDIO, MICHELLE R (RD)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:R
Last Name:DIDIO
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 1:18002 JUDICIAL WAY N
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-9381
Mailing Address - Country:US
Mailing Address - Phone:248-802-6028
Mailing Address - Fax:
Practice Address - Street 1:2945 HAZELWOOD ST
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1241
Practice Address - Country:US
Practice Address - Phone:651-232-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI892296133NN1002X
MN3503133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education