Provider Demographics
NPI:1760525158
Name:KING, JANICE L (RD, LDN, CDE)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:L
Last Name:KING
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 585
Mailing Address - Street 2:147 WEST MAIN STREET
Mailing Address - City:WEST BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01585-0585
Mailing Address - Country:US
Mailing Address - Phone:508-867-9735
Mailing Address - Fax:508-867-2600
Practice Address - Street 1:147 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WEST BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01585
Practice Address - Country:US
Practice Address - Phone:508-867-9735
Practice Address - Fax:508-867-2600
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1525133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA660137OtherACN GROUP
MA34906OtherHEALTH NEW ENGLAND
MA63-00292OtherUNITED HEALTH PLAN
MALD0065OtherBLUE CROSS BLUE SHIELD
MA468610OtherTUFTS HEALTH PLAN
MAAA1964OtherHARVARD PILGRIM
MA660137OtherACN GROUP
MALD0065OtherBLUE CROSS BLUE SHIELD