Provider Demographics
NPI:1952056806
Name:POGGENSEE, MICHELLE YVONNE (RD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:YVONNE
Last Name:POGGENSEE
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 1:2114 TRUMAN LN
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-3988
Mailing Address - Country:US
Mailing Address - Phone:925-783-7874
Mailing Address - Fax:
Practice Address - Street 1:2114 TRUMAN LN
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-3988
Practice Address - Country:US
Practice Address - Phone:925-783-7874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered