Provider Demographics
NPI:1689657140
Name:HAINES, DEVON E (MS RD CDE)
Entity Type:Individual
Prefix:MS
First Name:DEVON
Middle Name:E
Last Name:HAINES
Suffix:
Gender:F
Credentials:MS RD CDE
Other - Prefix:
Other - First Name:DEVON
Other - Middle Name:E
Other - Last Name:LONGACRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:75 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1795
Mailing Address - Country:US
Mailing Address - Phone:781-878-5200
Mailing Address - Fax:781-878-3989
Practice Address - Street 1:75 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1795
Practice Address - Country:US
Practice Address - Phone:781-878-5200
Practice Address - Fax:781-878-3989
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1530133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA0935OtherHVD PLIGRIM HEALTH CARE
MAJ13923OtherBCBS
MA41216OtherFALLON
MA702028OtherTUFTS
MA3110028Medicaid
MA702028OtherSECURE HORIZONS
MA0002160OtherNEIGHBORHOOD HLTH PLAN
MA0002160OtherNEIGHBORHOOD HLTH PLAN
MA702028OtherSECURE HORIZONS