Provider Demographics
NPI:1699127035
Name:CRADIT, KERRY
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:CRADIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 W LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9049
Mailing Address - Country:US
Mailing Address - Phone:734-302-7575
Mailing Address - Fax:
Practice Address - Street 1:3610 W LIBERTY RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9049
Practice Address - Country:US
Practice Address - Phone:734-302-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist