Basic Information
| Provider Information | |||||||||
| NPI: | 1891911806 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUYSEN-PEACOCK | ||||||||
| FirstName: | KAY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MS, RD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | DUYSEN | ||||||||
| OtherFirstName: | KAY | ||||||||
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| OtherCredential: | MS. RD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8333 FELCH ST | ||||||||
| Address2: | |||||||||
| City: | ZEELAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494641698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6167724644 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8333 FELCH ST | ||||||||
| Address2: | |||||||||
| City: | ZEELAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494641698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6167724644 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.