Basic Information
| Provider Information | |||||||||
| NPI: | 1740570381 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLVIN | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | SCULLY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS RD LDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 161 CRANBERRY RD | ||||||||
| Address2: | |||||||||
| City: | NORTH ATTLEBORO | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027604663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086432386 | ||||||||
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| Practice Location | |||||||||
| Address1: | 211 PARK ST | ||||||||
| Address2: | |||||||||
| City: | ATTLEBORO | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027033143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082225200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2011 | ||||||||
| LastUpdateDate: | 04/17/2011 | ||||||||
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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 | 1819 | MA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.