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General NPI Number Information
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NPI Number | 1760525158
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Entity Type | Individual
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Provider Name | JANICE L KING RD, LDN, CDE
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Gender | Female
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | 147 WEST MAIN STREET
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City | WEST BROOKFIELD
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State | MA
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Zip | 01585
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Country | US
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Telephone | 508-867-9735
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Fax | 508-867-2600
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Provider Business Mailing Address
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Address Line | PO BOX 585 147 WEST MAIN STREET
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City | WEST BROOKFIELD
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State | MA
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Zip | 01585-0585
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Country | US
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Telephone | 508-867-9735
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Fax | 508-867-2600
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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 | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | 1525
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License Number State | MA
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