Provider Demographics
NPI:1609022326
Name:ANDREJCIW, MARJIE CLARA (NC)
Entity Type:Individual
Prefix:
First Name:MARJIE
Middle Name:CLARA
Last Name:ANDREJCIW
Suffix:
Gender:F
Credentials:NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11517 HARTLAND RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2575
Mailing Address - Country:US
Mailing Address - Phone:810-629-7410
Mailing Address - Fax:
Practice Address - Street 1:11517 HARTLAND RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2575
Practice Address - Country:US
Practice Address - Phone:810-629-7410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist