Provider Demographics
NPI:1063261899
Name:WARD, CHRISTINE NICOLE
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:NICOLE
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 GLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1932
Mailing Address - Country:US
Mailing Address - Phone:518-605-2477
Mailing Address - Fax:
Practice Address - Street 1:137 GLENDALE RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-1932
Practice Address - Country:US
Practice Address - Phone:518-605-2477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN6544133V00000X
NY011148-01133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered