Provider Demographics
NPI:1588780019
Name:BIRD-CORTES, DALE LYNELL (MSRD)
Entity type:Individual
Prefix:MS
First Name:DALE
Middle Name:LYNELL
Last Name:BIRD-CORTES
Suffix:
Gender:F
Credentials:MSRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8541
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49422-8541
Mailing Address - Country:US
Mailing Address - Phone:616-836-7571
Mailing Address - Fax:616-738-1854
Practice Address - Street 1:22 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-6280
Practice Address - Country:US
Practice Address - Phone:616-836-7571
Practice Address - Fax:616-738-1854
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered