Provider Demographics
NPI:1740617596
Name:MAMIS, HILLARY MONROE (RD, LDN)
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:MONROE
Last Name:MAMIS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BEDFORD ST
Mailing Address - Street 2:SUTIE 20
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4319
Mailing Address - Country:US
Mailing Address - Phone:781-674-1189
Mailing Address - Fax:
Practice Address - Street 1:33 BEDFORD ST
Practice Address - Street 2:SUTIE 20
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4319
Practice Address - Country:US
Practice Address - Phone:781-674-1189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-10
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3389133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered