Provider Demographics
NPI:1467008227
Name:REARDON, CHRISTINA ANN
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANN
Last Name:REARDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HOSPITAL DR FL 3
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-6601
Mailing Address - Country:US
Mailing Address - Phone:413-535-4757
Mailing Address - Fax:413-535-4758
Practice Address - Street 1:11 HOSPITAL DR FL 3
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-6601
Practice Address - Country:US
Practice Address - Phone:413-535-4757
Practice Address - Fax:413-535-4758
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4852-NU-NU133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered