Provider Demographics
NPI:1659835049
Name:HARTLEY, MARY FRANCES HASTY (MS, RDN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:FRANCES HASTY
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:FRANCES
Other - Last Name:HASTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RDN, LDN
Mailing Address - Street 1:11800 SUNRISE VALLEY DR STE 700
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-5315
Mailing Address - Country:US
Mailing Address - Phone:703-834-1473
Mailing Address - Fax:
Practice Address - Street 1:11800 SUNRISE VALLEY DR STE 700
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-5315
Practice Address - Country:US
Practice Address - Phone:703-834-1473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86069089133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered