Healthcare Provider Details

I. General information

NPI: 1902171663
Provider Name (Legal Business Name): URSULA WHITNEY/NORTH SHORE NUTRITION CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 GARDEN ST STE 2
DANVERS MA
01923-1431
US

IV. Provider business mailing address

6 GARDEN ST STE 2
DANVERS MA
01923-1431
US

V. Phone/Fax

Practice location:
  • Phone: 978-535-6043
  • Fax:
Mailing address:
  • Phone: 978-535-6043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number460
License Number StateMA

VIII. Authorized Official

Name: ANN MARIE MCGRANE
Title or Position: OFFICE MANAGER
Credential:
Phone: 978-535-6043