Provider Demographics
NPI:1275774838
Name:CREAN, HAILEY (MS, RD, CDE)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:CREAN
Suffix:
Gender:F
Credentials:MS, RD, CDE
Other - Prefix:
Other - First Name:HAILEY
Other - Middle Name:
Other - Last Name:MACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 WALNUT PL
Mailing Address - Street 2:
Mailing Address - City:NEWTON HIGHLANDS
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1717
Mailing Address - Country:US
Mailing Address - Phone:206-708-9523
Mailing Address - Fax:833-893-0629
Practice Address - Street 1:24 WALNUT PL
Practice Address - Street 2:
Practice Address - City:NEWTON HIGHLANDS
Practice Address - State:MA
Practice Address - Zip Code:02461-1717
Practice Address - Country:US
Practice Address - Phone:206-708-9523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2832133V00000X
MA3594133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered