Provider Demographics
NPI:1891502266
Name:BOOKS, STACEY (RD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:BOOKS
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 1:10425 SANDPIPER CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-8044
Mailing Address - Country:US
Mailing Address - Phone:517-672-2115
Mailing Address - Fax:
Practice Address - Street 1:43155 MAIN ST STE 2212A
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1890
Practice Address - Country:US
Practice Address - Phone:248-847-1587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI957784133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered