Provider Demographics
NPI:1821413048
Name:CREECH, MICHELE (RD, LD, CNSC)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:CREECH
Suffix:
Gender:F
Credentials:RD, LD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WEST ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3405
Mailing Address - Country:US
Mailing Address - Phone:207-662-7180
Mailing Address - Fax:
Practice Address - Street 1:19 WEST ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3405
Practice Address - Country:US
Practice Address - Phone:207-662-7180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI645133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered