Provider Demographics
NPI:1619271095
Name:KING, GINNY R (RD, LDN)
Entity Type:Individual
Prefix:MISS
First Name:GINNY
Middle Name:R
Last Name:KING
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 1:11 PINE ST
Mailing Address - Street 2:UNIT #1
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3238
Mailing Address - Country:US
Mailing Address - Phone:978-518-2594
Mailing Address - Fax:
Practice Address - Street 1:11 PINE ST
Practice Address - Street 2:UNIT #1
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3238
Practice Address - Country:US
Practice Address - Phone:978-518-2594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2797133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered