Provider Demographics
NPI:1770080996
Name:JAKUB MAHER, ADALHEID KATRINA (LDN)
Entity type:Individual
Prefix:
First Name:ADALHEID
Middle Name:KATRINA
Last Name:JAKUB MAHER
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 THICKET ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1222
Mailing Address - Country:US
Mailing Address - Phone:617-413-0023
Mailing Address - Fax:
Practice Address - Street 1:300 OAK ST STE 155
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-1968
Practice Address - Country:US
Practice Address - Phone:781-924-1092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4139133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist