Individual
JEANETTE ILA WAITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED DIETITIAN
Contact information
Practice address
1212 E SHERMAN BLVD, MUSKEGON, MI 49444-1879
(231) 672-3648
(231) 672-3838
Mailing address
1212 E SHERMAN BLVD, MUSKEGON, MI 49444-1879
(231) 672-3648
(231) 672-3838
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
573775
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
N94150005
MEDICARE PTAN
MI
Enumeration date
12/10/2007
Last updated
05/04/2010
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