Provider Demographics
NPI:1477253235
Name:HALE, MARINA KASSANDRA (RD, LD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:KASSANDRA
Last Name:HALE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 OAKWOOD DR APT 1K
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3003
Mailing Address - Country:US
Mailing Address - Phone:818-378-2583
Mailing Address - Fax:
Practice Address - Street 1:5900 OAKWOOD DR APT 1K
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3003
Practice Address - Country:US
Practice Address - Phone:818-378-2583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered