NPI 1235868951 · live from the CMS NPI Registry
Makenna Bogaard
Dietitian, Registered in Troy, MI. National Provider Identifier 1235868951, active.
NPI record
| NPI | 1235868951 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 1777 Axtell Dr Ste 202, Troy, MI 48084 |
| Practice phone | 248-594-3142 |
| Mailing address | 26901 Beaumont Blvd, Southfield, MI 48033 |
| Enumerated | June 8, 2022 |
| Last updated | June 10, 2022 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.