Healthcare Provider Details

I. General information

NPI: 1871767699
Provider Name (Legal Business Name): ALISON R FERNALD R.D., L.D., CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 MEDICAL CENTER DR SUITE 2200
BRUNSWICK ME
04011-2764
US

IV. Provider business mailing address

81 MEDICAL CENTER DR SUITE 2200
BRUNSWICK ME
04011-2764
US

V. Phone/Fax

Practice location:
  • Phone: 207-406-7290
  • Fax: 207-406-7291
Mailing address:
  • Phone: 207-406-7290
  • Fax: 207-406-7291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberD1449
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD1449
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: