Healthcare Provider Details

I. General information

NPI: 1639592025
Provider Name (Legal Business Name): MOLLIE WRIGHT MS RD LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE FEGAN BUILDING, 5TH FLOOR
BOSTON MA
02115-5724
US

IV. Provider business mailing address

112 DECATUR ST APT 6
ARLINGTON MA
02474-3551
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-4677
  • Fax:
Mailing address:
  • Phone: 410-206-7923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3069
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: