Provider Demographics
NPI:1407611585
Name:HOOVER, VICTORIA LEE (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LEE
Last Name:HOOVER
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 PRINCETON ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:MA
Mailing Address - Zip Code:01522-1207
Mailing Address - Country:US
Mailing Address - Phone:978-257-1414
Mailing Address - Fax:
Practice Address - Street 1:410 PRINCETON ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:MA
Practice Address - Zip Code:01522-1207
Practice Address - Country:US
Practice Address - Phone:978-257-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2021-000149-NU-R133V00000X
86092494133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered