Provider Demographics
NPI:1154769941
Name:ULLREY, NANCY ANN (RD)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ANN
Last Name:ULLREY
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 1:3596 TRICKLEWOOD DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7246
Mailing Address - Country:US
Mailing Address - Phone:616-949-2732
Mailing Address - Fax:
Practice Address - Street 1:3596 TRICKLEWOOD DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7246
Practice Address - Country:US
Practice Address - Phone:616-949-2732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INR410665133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered