Provider Demographics
NPI:1144959305
Name:HUSKEY, ELYSE (RDN)
Entity type:Individual
Prefix:MRS
First Name:ELYSE
Middle Name:
Last Name:HUSKEY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44691 JODI CT
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3939
Mailing Address - Country:US
Mailing Address - Phone:248-931-3727
Mailing Address - Fax:
Practice Address - Street 1:44691 JODI CT
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-3939
Practice Address - Country:US
Practice Address - Phone:248-931-3727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-05
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86112437133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered