Provider Demographics
NPI:1063621522
Name:ALLEY, MONA DRISKO (RD)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:DRISKO
Last Name:ALLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:241 US ROUTE 1
Mailing Address - Street 2:STE 103
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4715
Mailing Address - Country:US
Mailing Address - Phone:207-380-2646
Mailing Address - Fax:207-563-3388
Practice Address - Street 1:241 US ROUTE 1
Practice Address - Street 2:STE 103
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4715
Practice Address - Country:US
Practice Address - Phone:207-380-2646
Practice Address - Fax:207-563-3388
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI196133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered