Provider Demographics
NPI:1265532873
Name:HUSTRULID, INGER K (RD LDN ACSM)
Entity type:Individual
Prefix:MS
First Name:INGER
Middle Name:K
Last Name:HUSTRULID
Suffix:
Gender:F
Credentials:RD LDN ACSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CARTHAY CIR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1106
Mailing Address - Country:US
Mailing Address - Phone:617-244-8444
Mailing Address - Fax:
Practice Address - Street 1:20 CARTHAY CIR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02461-1106
Practice Address - Country:US
Practice Address - Phone:617-244-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2168133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALD0158OtherBLUE CROSS - PROVIDER NUM
MALG0027OtherBLUE CROSS - GROUP NUMBER
MAAA17456OtherHARVARD PILGRIM
MA466524OtherTUFTS
MAAA17456OtherHARVARD PILGRIM
MAMT0715Medicare ID - Type UnspecifiedMEDICARE - GROUP NUMBER