Provider Demographics
NPI:1124192505
Name:POLLEY, JANE FRANCES (RD, LDN)
Entity Type:Individual
Prefix:MISS
First Name:JANE
Middle Name:FRANCES
Last Name:POLLEY
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 NAHANTON ST
Mailing Address - Street 2:BOX 106
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2954
Mailing Address - Country:US
Mailing Address - Phone:508-641-4321
Mailing Address - Fax:
Practice Address - Street 1:203 OAK ST
Practice Address - Street 2:LONGFELLOW SPORTS CLUB
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1306
Practice Address - Country:US
Practice Address - Phone:508-653-4633
Practice Address - Fax:508-650-4986
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN1011133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5582051OtherAETNA
MA39412OtherHARVARD PILGRIM HEALTH CA
MA763282OtherTUFTS
MALD0004OtherBLUE CROSS BLUE SHIELD
MA6300209OtherUNITED HEALTH CARE
MA763282OtherTUFTS