Provider Demographics
NPI:1770912859
Name:MACQUEEN, KATY ANN (MS, RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:KATY
Middle Name:ANN
Last Name:MACQUEEN
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:MS
Other - First Name:KATY
Other - Middle Name:ANN
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208 COLLYER ST FL 2
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1560
Mailing Address - Country:US
Mailing Address - Phone:401-793-5826
Mailing Address - Fax:
Practice Address - Street 1:208 COLLYER ST FL 2
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1560
Practice Address - Country:US
Practice Address - Phone:401-793-5826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00730133V00000X
MA3335133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered