Provider Demographics
NPI:1588969422
Name:BARTLETT, DARA JEAN (RD, LDN)
Entity type:Individual
Prefix:
First Name:DARA
Middle Name:JEAN
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SUMNER AVE
Mailing Address - Street 2:#3
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-2342
Mailing Address - Country:US
Mailing Address - Phone:413-262-7383
Mailing Address - Fax:413-209-9627
Practice Address - Street 1:85 SUMNER AVE
Practice Address - Street 2:#3
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-2342
Practice Address - Country:US
Practice Address - Phone:413-262-7383
Practice Address - Fax:413-209-9627
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000003111133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered