Provider Demographics
NPI:1033354667
Name:GLEASON, MARSA MARIE (RD)
Entity Type:Individual
Prefix:MS
First Name:MARSA
Middle Name:MARIE
Last Name:GLEASON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL HEALTH CLINIC NEW ENGLAND
Mailing Address - Street 2:43 SMITH ROAD
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-1006
Mailing Address - Country:US
Mailing Address - Phone:401-841-6773
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HEALTH CLINIC NEW ENGLAND
Practice Address - Street 2:43 SMITH ROAD
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-1006
Practice Address - Country:US
Practice Address - Phone:401-841-6773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2823133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered