Provider Demographics
NPI:1417609751
Name:COURTNEY B HUARD MS RD LDN, LLC
Entity Type:Organization
Organization Name:COURTNEY B HUARD MS RD LDN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:HUARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS RD LDN
Authorized Official - Phone:401-808-9574
Mailing Address - Street 1:655 MENDON RD STE 2C
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-6222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:655 MENDON RD STE 2C
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-6222
Practice Address - Country:US
Practice Address - Phone:401-808-9574
Practice Address - Fax:401-305-3137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty