Provider Demographics
NPI:1306170030
Name:LARYEA, EILEEN FAY (RD)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:FAY
Last Name:LARYEA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:FAY
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:737 BANCROFT CT
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48915-1931
Mailing Address - Country:US
Mailing Address - Phone:517-488-3702
Mailing Address - Fax:
Practice Address - Street 1:812 E JOLLY RD STE 216
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-6825
Practice Address - Country:US
Practice Address - Phone:517-346-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered