Provider Demographics
NPI:1225046642
Name:HANLON, MARY-JENNIFER (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:MARY-JENNIFER
Middle Name:
Last Name:HANLON
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 W POND RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4732
Mailing Address - Country:US
Mailing Address - Phone:508-747-6085
Mailing Address - Fax:
Practice Address - Street 1:16 ALDRIN RD
Practice Address - Street 2:PLYMOUTH NUTRITION
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4804
Practice Address - Country:US
Practice Address - Phone:508-746-7448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1232133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered