Provider Demographics
NPI:1184644551
Name:DAVIS, ERIN MARIE (MS, RD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MARIE
Other - Last Name:BRIERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:930 17TH RD
Mailing Address - Street 2:
Mailing Address - City:BARK RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49807-9599
Mailing Address - Country:US
Mailing Address - Phone:906-466-2782
Mailing Address - Fax:906-466-7454
Practice Address - Street 1:N15019 HANNAHVILLE B1 RD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:MI
Practice Address - Zip Code:49896
Practice Address - Country:US
Practice Address - Phone:906-466-2782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
963758OtherNAT REGISTRATION NUMBER