Basic Information
| Provider Information | |||||||||
| NPI: | 1528088317 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NORMAND | ||||||||
| FirstName: | POLLY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | MPH, RD, LDN, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 FRUIT ST | ||||||||
| Address2: | |||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010603807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137862957 | ||||||||
| FaxNumber: | 4137862977 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 FRUIT ST | ||||||||
| Address2: | |||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010603807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137862957 | ||||||||
| FaxNumber: | 4137862977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 06/10/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 2232 | MA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 4609501 | 01 | MA | CIGNA | OTHER | 11326384 | 01 | MA | CAQH | OTHER | LD0152 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER | 469911 | 01 | MA | TUFTS | OTHER | 35122 | 01 | MA | HEALTH NEW ENGLAND | OTHER | AA59459 | 01 | MA | HARVARD PILGRIM | OTHER |