Provider Demographics
NPI:1144796822
Name:HURTADO, MARY GRACE (RD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:GRACE
Last Name:HURTADO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:GRACE
Other - Last Name:FARONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1211 21ST AVE S 607 MEDICAL ARTS BUILDING
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-1320
Mailing Address - Country:US
Mailing Address - Phone:615-936-3952
Mailing Address - Fax:
Practice Address - Street 1:1211 21ST AVE S 607 MEDICAL ARTS BUILDING
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-1320
Practice Address - Country:US
Practice Address - Phone:615-936-3952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN86101821133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered