Trystan Robert Thayer, MS, RD
Dietitian, Registered in Grand Rapids, MI. Individual provider (NPI-1).
NPI number1457100034
StatusActive
Last updated in NPPESJul 8, 2024
Details
- NPI
- 1457100034
- Entity type
- Individual (NPI-1)
- Name
- Trystan Robert Thayer
- Credential
- MS, RD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 15, 2024
- Certification date
- Jul 8, 2024
- Last updated
- Jul 8, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 133V00000X | Dietitian, Registered | – | – | Yes |
Practice location
221 Michigan St Ne Ste 200Grand Rapids, MI 49503-2533
Phone 616-267-8950
Mailing address
100 Michigan St Ne # Mc845Grand Rapids, MI 49503-2560
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