Provider Demographics
NPI:1285721191
Name:AUBERTIN, AMY LOUISE (MS RD LDN)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:LOUISE
Last Name:AUBERTIN
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:191 DAMON ROAD
Mailing Address - Street 2:
Mailing Address - City:ASHBY
Mailing Address - State:MA
Mailing Address - Zip Code:01431
Mailing Address - Country:US
Mailing Address - Phone:781-674-1189
Mailing Address - Fax:978-386-0996
Practice Address - Street 1:33 BEDFORD STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420
Practice Address - Country:US
Practice Address - Phone:781-674-1189
Practice Address - Fax:978-386-0996
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA405133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered