Provider Demographics
NPI:1467228148
Name:WIDTH, MARY E (MS, RD, FAND)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:WIDTH
Suffix:
Gender:F
Credentials:MS, RD, FAND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29454 GRAMERCY CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-1336
Mailing Address - Country:US
Mailing Address - Phone:248-470-7089
Mailing Address - Fax:
Practice Address - Street 1:29454 GRAMERCY CT
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1336
Practice Address - Country:US
Practice Address - Phone:248-470-7089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered