Provider Demographics
NPI:1487289419
Name:ADAMS, MICHELLE DANIKA (RD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DANIKA
Last Name:ADAMS
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 1:910 SANTA ALICIA DR
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-3239
Mailing Address - Country:US
Mailing Address - Phone:786-442-7117
Mailing Address - Fax:
Practice Address - Street 1:910 SANTA ALICIA DR
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-3239
Practice Address - Country:US
Practice Address - Phone:340-642-6912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered