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Individual
NIDA KASED
Active
Individual
NIDA KASED
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
1020387
MI
163W00000X
Registered Nurse
4704350057
MI
363L00000X
Nurse Practitioner
Primary
4704350057
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1020387
COMMISSION ON DIETETIC REGISTRATION
MI
01
—
4704350057
DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS
MI
Enumeration date
02/12/2021
Last updated
10/29/2021
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