Healthcare Provider Details

I. General information

NPI: 1790757342
Provider Name (Legal Business Name): REBECCA A MARLEY LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WATER ST
HAVERHILL MA
01830-6223
US

IV. Provider business mailing address

40 SCHOOL ST
HAVERHILL MA
01830-6306
US

V. Phone/Fax

Practice location:
  • Phone: 978-372-0377
  • Fax:
Mailing address:
  • Phone: 978-521-0632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberNU2419
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: