Provider Demographics
NPI:1558830083
Name:MERCURY, DENISE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:MERCURY
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CROSBY DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1402
Mailing Address - Country:US
Mailing Address - Phone:781-221-7177
Mailing Address - Fax:
Practice Address - Street 1:26 CROSBY DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1402
Practice Address - Country:US
Practice Address - Phone:781-221-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2445133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered