Individual
ANGELA D PAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CSO
Contact information
Practice address
100 MICHIGAN ST NE, MEDICAL NUTRITION THERAPY, GRAND RAPIDS, MI 49503
(616) 391-6578
Mailing address
100 MICHIGAN STREET NE, MEDICAL NUTRITION THERAPY MC 059, GRAND RAPIDS, MI 49506
(616) 391-6578
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
873698
COMMISSION ON DIETETIC REGISTRATION
MI
Enumeration date
09/29/2011
Last updated
01/28/2020
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