Provider Demographics
NPI:1427889062
Name:HAZEL, ERIN (RD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:HAZEL
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 1:1060 BARNWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348
Mailing Address - Country:US
Mailing Address - Phone:269-225-9588
Mailing Address - Fax:
Practice Address - Street 1:1060 BARNWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348
Practice Address - Country:US
Practice Address - Phone:269-225-9588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND13453133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered