Healthcare Provider Details

I. General information

NPI: 1669697975
Provider Name (Legal Business Name): DEBRA HOLLON M.S., R.D, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 CAMBRIDGE STREET SUITE 402
BOSTON MA
02114
US

IV. Provider business mailing address

165 CAMBRIDGE STREET SUITE 402
BOSTON MA
02114
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-0905
  • Fax: 617-726-4277
Mailing address:
  • Phone: 617-724-0905
  • Fax: 617-726-4277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number921319
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: