Provider Demographics
NPI:1932890308
Name:BACKUS, KARSYN CADENA (RDN)
Entity Type:Individual
Prefix:
First Name:KARSYN
Middle Name:CADENA
Last Name:BACKUS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12065 GRASS RD
Mailing Address - Street 2:
Mailing Address - City:SEBEWAING
Mailing Address - State:MI
Mailing Address - Zip Code:48759-9549
Mailing Address - Country:US
Mailing Address - Phone:989-977-1404
Mailing Address - Fax:
Practice Address - Street 1:12065 GRASS RD
Practice Address - Street 2:
Practice Address - City:SEBEWAING
Practice Address - State:MI
Practice Address - Zip Code:48759-9549
Practice Address - Country:US
Practice Address - Phone:989-977-1404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86289755133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered