Provider Demographics
NPI:1952676546
Name:HADLEY, MERYL ANN (RD)
Entity Type:Individual
Prefix:MRS
First Name:MERYL
Middle Name:ANN
Last Name:HADLEY
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 1:13901 E JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-2720
Mailing Address - Country:US
Mailing Address - Phone:313-822-0900
Mailing Address - Fax:
Practice Address - Street 1:13901 E JEFFERSON AVE
Practice Address - Street 2:7900 KERCHEVAL ST
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2720
Practice Address - Country:US
Practice Address - Phone:313-822-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIR457151133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered