Provider Demographics
NPI:1710158845
Name:BLINSTRUB, LEAH BETH (RD)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:BETH
Last Name:BLINSTRUB
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:LEAH
Other - Middle Name:BETH
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:4986 N ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48306-5017
Mailing Address - Country:US
Mailing Address - Phone:248-475-4728
Mailing Address - Fax:
Practice Address - Street 1:30061 SCHOENHERR RD
Practice Address - Street 2:SUITE C
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-3133
Practice Address - Country:US
Practice Address - Phone:248-475-4728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI947589133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered