Basic Information
| Provider Information | |||||||||
| NPI: | 1386295509 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARTNETT | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | MARIAN | ||||||||
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| Credential: | RD, LD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 266A DEPOT RD | ||||||||
| Address2: | |||||||||
| City: | HOLLIS | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030496581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184879366 | ||||||||
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| Practice Location | |||||||||
| Address1: | 163 GORE ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021411119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176653000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2019 | ||||||||
| LastUpdateDate: | 09/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 1039 | NH | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | 4901-NU-NU | MA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.