Healthcare Provider Details

I. General information

NPI: 1205178118
Provider Name (Legal Business Name): PYRAMID NUTRITION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 MAIN ST
SPRINGFIELD MA
01103-2105
US

IV. Provider business mailing address

870 MAIN ST
SPRINGFIELD MA
01103-2105
US

V. Phone/Fax

Practice location:
  • Phone: 413-427-6340
  • Fax: 413-480-0517
Mailing address:
  • Phone: 413-427-6340
  • Fax: 413-480-0517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1705
License Number StateMA

VIII. Authorized Official

Name: MRS. NICOLE KATHLEEN FRANK-MASLAR
Title or Position: OWNER
Credential: RD, LDN
Phone: 413-427-6340