Provider Demographics
NPI:1841339801
Name:MORIN, GRETCHEN KAUTH (RD, MED)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:KAUTH
Last Name:MORIN
Suffix:
Gender:F
Credentials:RD, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6447 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-2309
Mailing Address - Country:US
Mailing Address - Phone:269-329-1959
Mailing Address - Fax:269-387-2944
Practice Address - Street 1:1903 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-5200
Practice Address - Country:US
Practice Address - Phone:269-387-3287
Practice Address - Fax:269-387-2944
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI711933OtherAM. DIETETIC ASS.MEMBER