Healthcare Provider Details

I. General information

NPI: 1821297425
Provider Name (Legal Business Name): LYNN D OREILLY MS,RD,LDN,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

298 WASHINGTON ST
GLOUCESTER MA
01930-4832
US

IV. Provider business mailing address

298 WASHINGTON ST
GLOUCESTER MA
01930-4832
US

V. Phone/Fax

Practice location:
  • Phone: 978-283-4000
  • Fax: 978-646-7016
Mailing address:
  • Phone: 978-283-4000
  • Fax: 978-646-7016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number169
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: