Provider Demographics
NPI:1871922682
Name:JESUE, PATRIZIA (RD)
Entity type:Individual
Prefix:MRS
First Name:PATRIZIA
Middle Name:
Last Name:JESUE
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 1:3910 TELEGRAPH RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1420
Mailing Address - Country:US
Mailing Address - Phone:248-686-0340
Mailing Address - Fax:248-686-0340
Practice Address - Street 1:3910 TELEGRAPH RD
Practice Address - Street 2:SUITE 202
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-1420
Practice Address - Country:US
Practice Address - Phone:248-686-0340
Practice Address - Fax:248-686-0340
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI837377133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered