Individual
MICHON KYSILKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
913 NW GARDEN VALLEY BLVD, ROSEBURG, OR 97471-6523
(541) 440-1000
Mailing address
4955 28TH AVE S APT 212, FARGO, ND 58104-8472
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
943
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
800330629
BLUE CROSS BLUE SHIELD
ND
Enumeration date
10/21/2015
Last updated
09/13/2017
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