Individual
STACEY NIESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2215 44TH ST SE, GRAND RAPIDS, MI 49508-5013
(616) 252-8339
Mailing address
2215 44TH ST SE, GRAND RAPIDS, MI 49508-5013
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1041435
MI
Other
Enumeration date
07/21/2015
Last updated
07/21/2015
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