Provider Demographics
NPI:1922251776
Name:DOWLING, NANCY (MSRDCDE)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:DOWLING
Suffix:
Gender:F
Credentials:MSRDCDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 DORCHESTER AVENUE
Mailing Address - Street 2:OUTPATIENT NUTRITION
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5666
Mailing Address - Country:US
Mailing Address - Phone:617-506-4982
Mailing Address - Fax:
Practice Address - Street 1:2100 DORCHESTER AVENUE
Practice Address - Street 2:OUTPATIENT NUTRITION
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5666
Practice Address - Country:US
Practice Address - Phone:617-506-4982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1101133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered