Provider Demographics
NPI:1427476985
Name:RAYMOND, NIXIE GRACE (MS, RD)
Entity type:Individual
Prefix:MS
First Name:NIXIE
Middle Name:GRACE
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 EASTBOURNE ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-3313
Mailing Address - Country:US
Mailing Address - Phone:617-818-3128
Mailing Address - Fax:
Practice Address - Street 1:12 EASTBOURNE ST
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-3313
Practice Address - Country:US
Practice Address - Phone:617-818-3128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1460133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered