Provider Demographics
NPI:1275608028
Name:DUBOIS, CHRISTINE WISNIOWIECKI (RD)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:WISNIOWIECKI
Last Name:DUBOIS
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 1:4260 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-2707
Mailing Address - Country:US
Mailing Address - Phone:734-647-5655
Mailing Address - Fax:734-615-4888
Practice Address - Street 1:4260 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-2707
Practice Address - Country:US
Practice Address - Phone:734-647-5655
Practice Address - Fax:734-615-4888
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered