Basic Information
| Provider Information | |||||||||
| NPI: | 1649412008 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUNSELL | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 789 | ||||||||
| Address2: | |||||||||
| City: | LUDLOW | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010560789 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135091000 | ||||||||
| FaxNumber: | 4135091003 | ||||||||
| Practice Location | |||||||||
| Address1: | 14 S WESTFIELD ST | ||||||||
| Address2: | |||||||||
| City: | FEEDING HILLS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010302702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137862957 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2009 | ||||||||
| LastUpdateDate: | 10/06/2009 | ||||||||
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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 | 133N00000X | 1204 | MA | Y | Dietary & Nutritional Service Providers | Nutritionist |
No ID Information.