Provider Demographics
NPI:1538386396
Name:GRUNER, MANDY MICHELE (MS, RD, CSSD)
Entity type:Individual
Prefix:MS
First Name:MANDY
Middle Name:MICHELE
Last Name:GRUNER
Suffix:
Gender:F
Credentials:MS, RD, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 PARCHMENT DR SE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2307
Mailing Address - Country:US
Mailing Address - Phone:616-957-7700
Mailing Address - Fax:616-957-7773
Practice Address - Street 1:826 PARCHMENT DR SE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2307
Practice Address - Country:US
Practice Address - Phone:616-957-7700
Practice Address - Fax:616-957-7773
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered