Provider Demographics
NPI:1851892848
Name:HARTWELL, LEIGH CROTEAU (RD)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:CROTEAU
Last Name:HARTWELL
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 1:12 LILLIAN TER
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-2903
Mailing Address - Country:US
Mailing Address - Phone:978-809-0027
Mailing Address - Fax:
Practice Address - Street 1:280 MERRIMACK ST STE 400
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1787
Practice Address - Country:US
Practice Address - Phone:978-651-3023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1042314133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered