Provider Demographics
NPI:1902011828
Name:ANDERSON, NANCY (MS,RD,LDN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS,RD,LDN
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:LETENDRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:57 TAMARACK DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01129-1942
Mailing Address - Country:US
Mailing Address - Phone:413-783-2025
Mailing Address - Fax:413-794-4949
Practice Address - Street 1:759 CHESTNUT ST
Practice Address - Street 2:FOOD AND NUTRITION SERVICES C1340
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01199-1001
Practice Address - Country:US
Practice Address - Phone:413-794-4961
Practice Address - Fax:413-794-4949
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA297133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered