Provider Demographics
NPI:1104291400
Name:DENNY, DEANNA (RD)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:DENNY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23455 HAGGERTY RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3726
Mailing Address - Country:US
Mailing Address - Phone:248-962-5201
Mailing Address - Fax:
Practice Address - Street 1:23455 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-3726
Practice Address - Country:US
Practice Address - Phone:248-962-5201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2023-06-12
Deactivation Date:2019-09-06
Deactivation Code:
Reactivation Date:2023-06-12
Provider Licenses
StateLicense IDTaxonomies
MI1057872133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered