Provider Demographics
NPI:1376916684
Name:TRINA WEBER, MS, RD, LLC
Entity Type:Organization
Organization Name:TRINA WEBER, MS, RD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:269-873-9108
Mailing Address - Street 1:4341 S WESTNEDGE AVE
Mailing Address - Street 2:SUITE 2106
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-3289
Mailing Address - Country:US
Mailing Address - Phone:269-873-9108
Mailing Address - Fax:269-544-2460
Practice Address - Street 1:4341 S WESTNEDGE AVE
Practice Address - Street 2:SUITE 2106
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3289
Practice Address - Country:US
Practice Address - Phone:269-873-9108
Practice Address - Fax:269-544-2460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI926499261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI13638513OtherCAQH