Provider Demographics
NPI:1205133584
Name:MCMURTERY, MICHELLE ANN (RD, CSR, LDN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:MCMURTERY
Suffix:
Gender:F
Credentials:RD, CSR, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 E LAKE MARY AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3046
Mailing Address - Country:US
Mailing Address - Phone:808-446-5018
Mailing Address - Fax:
Practice Address - Street 1:172 E LAKE MARY AVE
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3046
Practice Address - Country:US
Practice Address - Phone:808-446-5018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6335133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered