Provider Demographics
NPI:1326352956
Name:MORA, KATI E (RD)
Entity Type:Individual
Prefix:MRS
First Name:KATI
Middle Name:E
Last Name:MORA
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 1:120 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2310
Mailing Address - Country:US
Mailing Address - Phone:989-400-1478
Mailing Address - Fax:989-317-0692
Practice Address - Street 1:120 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2310
Practice Address - Country:US
Practice Address - Phone:989-400-1478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered