Healthcare Provider Details

I. General information

NPI: 1013299668
Provider Name (Legal Business Name): MJH NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 ALDRIN ROAD PLYMOUTH FITNESS
PLYMOUTH MA
02360-9998
US

IV. Provider business mailing address

39 W POND RD
PLYMOUTH MA
02360-4732
US

V. Phone/Fax

Practice location:
  • Phone: 508-746-7448
  • Fax: 508-746-6608
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MARY-JENNIFER HANLON
Title or Position: OWNER/REGISTERED DIETITIAN
Credential:
Phone: 508-746-7448