Provider Demographics
NPI:1821216961
Name:EUELL, MARY JANE P (RD)
Entity Type:Individual
Prefix:MRS
First Name:MARY JANE
Middle Name:P
Last Name:EUELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 RUTHERFORD AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2830
Mailing Address - Country:US
Mailing Address - Phone:401-732-9883
Mailing Address - Fax:401-732-9673
Practice Address - Street 1:65 RUTHERFORD AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2830
Practice Address - Country:US
Practice Address - Phone:401-732-9883
Practice Address - Fax:401-732-9673
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00155133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered