Basic Information
| Provider Information | |||||||||
| NPI: | 1902011828 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | |||||||||
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| Credential: | MS,RD,LDN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LETENDRE | ||||||||
| OtherFirstName: | NANCY | ||||||||
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| OtherCredential: | BS | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 57 TAMARACK DR | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011291942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137832025 | ||||||||
| FaxNumber: | 4137944949 | ||||||||
| Practice Location | |||||||||
| Address1: | 759 CHESTNUT ST | ||||||||
| Address2: | FOOD AND NUTRITION SERVICES C1340 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011991001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137944961 | ||||||||
| FaxNumber: | 4137944949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 297 | MA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.