Provider Demographics
NPI:1497908024
Name:LONERGAN, MARY SUSAN (RD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUSAN
Last Name:LONERGAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17557 WESTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-5708
Mailing Address - Country:US
Mailing Address - Phone:734-502-7289
Mailing Address - Fax:734-464-4811
Practice Address - Street 1:17557 WESTBROOK DR
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-5708
Practice Address - Country:US
Practice Address - Phone:734-502-7289
Practice Address - Fax:734-464-4811
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered