Individual
MS. TRACY M BLAKEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., R.D.
Contact information
Practice address
2727 VALLEY RIDGE DR, MIDDLEVILLE, MI 49333-9157
(616) 633-3549
Mailing address
2727 VALLEY RIDGE DR, MIDDLEVILLE, MI 49333-9157
(616) 633-3549
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
721639
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
133V00000X
—
MI
Enumeration date
07/15/2010
Last updated
07/15/2010
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