Provider Demographics
NPI:1619008109
Name:HARRIS BLYTHE, ARLEEN DENISE (RD)
Entity type:Individual
Prefix:
First Name:ARLEEN
Middle Name:DENISE
Last Name:HARRIS BLYTHE
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 1:1151 TAYLOR STREET, 2-C WING
Mailing Address - Street 2:DETROIT HEALTH DEPARTMENT - HERMAN KIEFER HEALTH COMPLE
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1732
Mailing Address - Country:US
Mailing Address - Phone:313-876-4558
Mailing Address - Fax:313-876-4645
Practice Address - Street 1:DETROIT HEALTH DEPT - HERMAN KIEFER HEALTH COMPLEX
Practice Address - Street 2:1151 TAYLOR STREET, WING , 2C
Practice Address - City:DETRIOT
Practice Address - State:MI
Practice Address - Zip Code:48202-1732
Practice Address - Country:US
Practice Address - Phone:313-876-4558
Practice Address - Fax:313-876-4645
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIR357296133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH26164136Medicare ID - Type Unspecified