Provider Demographics
NPI:1336556323
Name:PAWLAK, MICHELLE EVANTHE (RD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:EVANTHE
Last Name:PAWLAK
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 1:16792 LASH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-6728
Mailing Address - Country:US
Mailing Address - Phone:949-350-7230
Mailing Address - Fax:
Practice Address - Street 1:16792 LASH ST
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-6728
Practice Address - Country:US
Practice Address - Phone:949-350-7230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered