Individual
JUDITH DONNELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.,L.D.
Contact information
Practice address
805 STEVENS AVE, PORTLAND, ME 04103-2626
(207) 772-6279
(207) 772-6279
Mailing address
805 STEVENS AVE, PORTLAND, ME 04103-2626
(207) 772-6279
(207) 772-6279
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D1433
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11339866
CAQH PROVIDER ID
ME
Enumeration date
08/13/2006
Last updated
07/09/2007
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