Provider Demographics
NPI:1255490280
Name:PRESTON, MICHELLE KATHRYN (RD, LDN, CDE)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:KATHRYN
Last Name:PRESTON
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SUNSET HILLS PROFESSIONAL CTR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-3760
Mailing Address - Country:US
Mailing Address - Phone:618-659-8592
Mailing Address - Fax:618-659-8687
Practice Address - Street 1:8 SUNSET HILLS PROFESSIONAL CTR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3760
Practice Address - Country:US
Practice Address - Phone:618-659-8592
Practice Address - Fax:618-659-8687
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered