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General NPI Number Information
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NPI Number | 1295951143
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Entity Type | Individual
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Provider Name | MARA ROSE SANSEVERO REGISTERED DIETITIAN
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Gender | Female
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 08/04/2011
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Provider Practice Location Address
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Address Line | 301 S HUNTINGTON AVE BRIGHAM & WOMEN'S ADVANCED PRIMARY CARE ASSOCIATES, SH
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130-4807
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Country | US
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Telephone | 857-307-3364
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Fax |
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Provider Business Mailing Address
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Address Line | 301 S HUNTINGTON AVE BRIGHAM & WOMEN'S ADVANCED PRIMARY CARE ASSOCIATES, SH
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130-4807
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Country | US
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Telephone | 857-307-3364
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 2140
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License Number State | MA
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