Provider Demographics
NPI:1639649957
Name:PLESAC, MARY J (RD LD MED)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:J
Last Name:PLESAC
Suffix:
Gender:F
Credentials:RD LD MED
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:J
Other - Last Name:COVEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:26 LAUREL CREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:NH
Mailing Address - Zip Code:03033
Mailing Address - Country:US
Mailing Address - Phone:603-801-1564
Mailing Address - Fax:
Practice Address - Street 1:26 LAUREL CREST DRIVE
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:NH
Practice Address - Zip Code:03033
Practice Address - Country:US
Practice Address - Phone:603-801-1564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH690880133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered