Individual
MRS. MICHELE MARIE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
2401 W MAIN ST, MARION, IL 62959-1188
(618) 997-5311
Mailing address
2401 W MAIN ST, MARION, IL 62959-1188
(618) 997-5311
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164.005412
IL
Other
Enumeration date
05/31/2012
Last updated
05/31/2012
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