Individual
MICAH ANNE NESSELRODT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2301 HOLMES ST, KANSAS CITY, MO 64108-2640
(816) 404-2483
Mailing address
2301 HOLMES ST, KANSAS CITY, MO 64108-2640
(816) 404-2483
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2014034368
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2014034368
STATE OF MISSOURI
MO
Enumeration date
08/19/2016
Last updated
08/19/2016
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