Healthcare Provider Details

I. General information

NPI: 1285613794
Provider Name (Legal Business Name): ANN YELMOKAS MCDERMOTT PHD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 PEMBROKE ST
BOSTON MA
02118-1207
US

IV. Provider business mailing address

115 PEMBROKE ST
BOSTON MA
02118-1207
US

V. Phone/Fax

Practice location:
  • Phone: 617-262-7172
  • Fax:
Mailing address:
  • Phone: 617-262-7172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberNU 1320
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: