Provider Demographics
NPI:1568415198
Name:KINZLER, MICHELE ESTHER (RD)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ESTHER
Last Name:KINZLER
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 1:5N858 DOMINION DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-8224
Mailing Address - Country:US
Mailing Address - Phone:630-584-6407
Mailing Address - Fax:
Practice Address - Street 1:7 BLANCHARD CIR
Practice Address - Street 2:DANADA WELLNESS CENTER, LOWER LEVEL A
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-1037
Practice Address - Country:US
Practice Address - Phone:630-681-5606
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered