Provider Demographics
NPI:1154592491
Name:ACKERMAN, PAULA MARIE (MS RD CDE)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:MARIE
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:MS RD CDE
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:MARIE
Other - Last Name:VAN LANDSCHOOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 SAND POINT RD
Mailing Address - Street 2:
Mailing Address - City:MUNISING
Mailing Address - State:MI
Mailing Address - Zip Code:49862
Mailing Address - Country:US
Mailing Address - Phone:906-387-4110
Mailing Address - Fax:906-387-3514
Practice Address - Street 1:1500 SAND POINT RD
Practice Address - Street 2:
Practice Address - City:MUNISING
Practice Address - State:MI
Practice Address - Zip Code:49862
Practice Address - Country:US
Practice Address - Phone:906-387-4110
Practice Address - Fax:906-387-3514
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI800473133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered