Basic Information
Provider Information | |||||||||
NPI: | 1043562713 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | STEVENS | ||||||||
FirstName: | MAGARET | ||||||||
MiddleName: | HOWARD | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | RD, LDN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 10 CENTENNIAL DR STE 104 | ||||||||
Address2: |   | ||||||||
City: | PEABODY | ||||||||
State: | MA | ||||||||
PostalCode: | 019602298 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9785351110 | ||||||||
FaxNumber: | 9785352907 | ||||||||
Practice Location | |||||||||
Address1: | 10 CENTENNIAL DR STE 104 | ||||||||
Address2: |   | ||||||||
City: | PEABODY | ||||||||
State: | MA | ||||||||
PostalCode: | 019602298 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9785351110 | ||||||||
FaxNumber: | 9785352907 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/05/2012 | ||||||||
LastUpdateDate: | 06/04/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 3351 | MA | Y |   | Dietary & Nutritional Service Providers | Dietitian, Registered |   |
ID Information
ID | Type | State | Issuer | Description | 01030853 | 01 |   | ACADEMY OF NUTRITION AND DIETETICS | OTHER | 3351 | 01 | MA | COMMONWEALTH OF MASSACHUSETTS, DIVISION OF PROFESSIONAL LICENSURE, BOARD OF DIET | OTHER |