Individual
STACY WITTHOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
701 S HEALTH PKWY, THREE RIVERS, MI 49093-8352
(269) 278-1145
(269) 273-9746
Mailing address
701 S HEALTH PKWY, MEDICAL STAFF OFFICE, THREE RIVERS, MI 49093-8352
(269) 273-9789
(269) 273-9611
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
858814
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0N99470
MEDICARE GROUP
MI
Enumeration date
07/25/2007
Last updated
06/30/2008
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