Provider Demographics
NPI:1225242852
Name:MANSON, MICHELE (RD,LD)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:MANSON
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:FLOREANI
Other - Last Name:MANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD,LD
Mailing Address - Street 1:1320 MERCY DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2614
Mailing Address - Country:US
Mailing Address - Phone:330-489-1099
Mailing Address - Fax:330-489-1346
Practice Address - Street 1:1320 MERCY DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2614
Practice Address - Country:US
Practice Address - Phone:330-489-1099
Practice Address - Fax:330-489-1346
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD4342133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered