| Doctor Name: | MS. ANDREA JAN LASICHAK |
| NPI Number: | 1619093044 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, RD, CDE |
| License Number: | |
| Business Practice Address: | 8135 Stonehedge Rd Gregory, MI - 481379753 |
| Business Phone Number: | 7344331615 |
| Business Fax Number: | |
| Mailing Address: | 8135 Stonehedge Rd, GREGORY |
| State: | MI |
| Postal Code: | 481379753 |
| Phone Number: | 7344331615 |
| Fax Number: | |
| NPI Enumeration Date: | 03/21/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133VN1006X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | Nutrition, Metabolic |
| Taxonomy Definition: | |