Provider Demographics
NPI:1619511037
Name:KUETTEL, SHANIA JEAN (RDN)
Entity Type:Individual
Prefix:MISS
First Name:SHANIA
Middle Name:JEAN
Last Name:KUETTEL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N11601 LUCKE LANE I 3
Mailing Address - Street 2:
Mailing Address - City:DAGGETT
Mailing Address - State:MI
Mailing Address - Zip Code:49821-9624
Mailing Address - Country:US
Mailing Address - Phone:906-250-8040
Mailing Address - Fax:
Practice Address - Street 1:3401 LUDINGTON ST
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1300
Practice Address - Country:US
Practice Address - Phone:906-786-5707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86151478133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered