Provider Demographics
NPI:1992024632
Name:LARK, NANCY ANN (MSMS,MMS, RD, FAAMFM)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:LARK
Suffix:
Gender:
Credentials:MSMS,MMS, RD, FAAMFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 HIGHLAND AVE STE 223
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1516
Mailing Address - Country:US
Mailing Address - Phone:248-872-5574
Mailing Address - Fax:
Practice Address - Street 1:510 HIGHLAND AVE STE 223
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1516
Practice Address - Country:US
Practice Address - Phone:248-872-5574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No174H00000XOther Service ProvidersHealth Educator
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialist