Provider Demographics
NPI:1255530812
Name:RIPPLE, MICHELLE CHERIE' (MS, MS, RD)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:CHERIE'
Last Name:RIPPLE
Suffix:
Gender:F
Credentials:MS, MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2122
Mailing Address - Country:US
Mailing Address - Phone:818-662-9062
Mailing Address - Fax:
Practice Address - Street 1:836 GRANT AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2122
Practice Address - Country:US
Practice Address - Phone:818-662-9062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
896736133N00000X, 133NN1002X, 133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric