Provider Demographics
NPI:1760632376
Name:PLAISTED, DENISE ANNE (RD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:ANNE
Last Name:PLAISTED
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 1:20861 MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-1252
Mailing Address - Country:US
Mailing Address - Phone:734-675-1988
Mailing Address - Fax:734-676-7368
Practice Address - Street 1:20861 MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:GROSSE ILE
Practice Address - State:MI
Practice Address - Zip Code:48138-1252
Practice Address - Country:US
Practice Address - Phone:734-675-1988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI518620133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered