Provider Demographics
NPI:1265627582
Name:SPRINGER, MICHELLE (RD, LDN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SPRINGER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 KANE RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19543-9549
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 MAIN ST # 857
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:PA
Practice Address - Zip Code:19543-7746
Practice Address - Country:US
Practice Address - Phone:610-202-2861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003785133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered