Provider Demographics
NPI:1295225472
Name:HYSO, NAOMI
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:HYSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WEST SHORE COMMUNITY COLLEGE REC CENTER
Mailing Address - Street 2:3000 STILES RD
Mailing Address - City:SCOTTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49454
Mailing Address - Country:US
Mailing Address - Phone:231-845-3362
Mailing Address - Fax:231-845-2652
Practice Address - Street 1:WEST SHORE COMMUNITY COLLEGE REC CENTER
Practice Address - Street 2:3000 STILES RD
Practice Address - City:SCOTTVILLE
Practice Address - State:MI
Practice Address - Zip Code:49454
Practice Address - Country:US
Practice Address - Phone:231-845-3362
Practice Address - Fax:231-845-2652
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education