Provider Demographics
NPI:1801811583
Name:ENDYKE, JOAN NICOLE (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:NICOLE
Last Name:ENDYKE
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4616
Mailing Address - Country:US
Mailing Address - Phone:781-749-9042
Mailing Address - Fax:
Practice Address - Street 1:364 GRANITE AVE
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-5025
Practice Address - Country:US
Practice Address - Phone:617-698-0260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1003133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered