Provider Demographics
NPI:1649960956
Name:IVES, DANA LYNN (MS, RD)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:IVES
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 LANGDON AVE NE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3540
Mailing Address - Country:US
Mailing Address - Phone:269-932-8371
Mailing Address - Fax:
Practice Address - Street 1:142 LANGDON AVE NE UNIT 2
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3540
Practice Address - Country:US
Practice Address - Phone:269-932-8371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86151423133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered