Provider Demographics
NPI:1831401736
Name:MANZIE, MICHELE LYNN (RD)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:LYNN
Last Name:MANZIE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:LYNN
Other - Last Name:ROSSMEISSL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13823 JAFFA CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0282
Mailing Address - Country:US
Mailing Address - Phone:904-557-8543
Mailing Address - Fax:
Practice Address - Street 1:13823 JAFFA CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-0282
Practice Address - Country:US
Practice Address - Phone:904-557-8543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 5680133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered