Provider Demographics
NPI:1568863934
Name:MACKEEN, JANE (RD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:MACKEEN
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 1:47 WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-2935
Mailing Address - Country:US
Mailing Address - Phone:617-835-6156
Mailing Address - Fax:
Practice Address - Street 1:47 WASHINGTON DR
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-2935
Practice Address - Country:US
Practice Address - Phone:617-835-6156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA86034689133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered