Provider Demographics
NPI:1104928472
Name:MANZI, ANN ELAINE (MS RD LDN)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:ELAINE
Last Name:MANZI
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 EVERETT STREET
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2112
Mailing Address - Country:US
Mailing Address - Phone:978-922-2111
Mailing Address - Fax:
Practice Address - Street 1:16 EVERETT STREET
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2112
Practice Address - Country:US
Practice Address - Phone:978-922-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA453133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMT0067Medicare ID - Type Unspecified