Healthcare Provider Details

I. General information

NPI: 1750683009
Provider Name (Legal Business Name): HAYLEY FENNESSY SMART MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS HAYLEY FENNESSY

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MUIR RD
MARTINEZ CA
94553-4668
US

IV. Provider business mailing address

150 MUIR RD
MARTINEZ CA
94553-4668
US

V. Phone/Fax

Practice location:
  • Phone: 925-372-2356
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1042775
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1042775
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1042775
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number1042775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: