Provider Demographics
NPI:1669697975
Name:HOLLON, DEBRA (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:HOLLON
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 CAMBRIDGE STREET
Mailing Address - Street 2:SUITE 402
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-724-0905
Mailing Address - Fax:617-726-4277
Practice Address - Street 1:165 CAMBRIDGE STREET
Practice Address - Street 2:SUITE 402
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-724-0905
Practice Address - Fax:617-726-4277
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA921319133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered