Provider Demographics
NPI:1972653467
Name:ERICKSON, ARLENE M (RD, CDE)
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:M
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 ELLIOTT DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1032
Mailing Address - Country:US
Mailing Address - Phone:734-712-2660
Mailing Address - Fax:734-712-1391
Practice Address - Street 1:5320 ELLIOTT DR
Practice Address - Street 2:SUITE 203
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1032
Practice Address - Country:US
Practice Address - Phone:734-712-2660
Practice Address - Fax:734-712-1391
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI002960Medicare ID - Type UnspecifiedMNT PROVIDER