Provider Demographics
NPI:1902416266
Name:HUNTLEY, CHRISTINE (RD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:HUNTLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:GELHAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46 BROADWAY AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-2001
Mailing Address - Country:US
Mailing Address - Phone:617-417-4870
Mailing Address - Fax:
Practice Address - Street 1:225 MAIN ST STE 14
Practice Address - Street 2:
Practice Address - City:WENHAM
Practice Address - State:MA
Practice Address - Zip Code:01984-1459
Practice Address - Country:US
Practice Address - Phone:978-238-8175
Practice Address - Fax:877-743-5351
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA86105998133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX924808OtherLICENSE