Provider Demographics
NPI:1346042744
Name:HAM, MAUREEN PRYATEL
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:PRYATEL
Last Name:HAM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 LATHAM CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3439
Mailing Address - Country:US
Mailing Address - Phone:440-539-8716
Mailing Address - Fax:
Practice Address - Street 1:3000 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1219
Practice Address - Country:US
Practice Address - Phone:845-246-3029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered