Individual
MRS. DIANE H. HANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
2194 MAIN ST, OFC 6, CONCORD, MA 01742-3829
(978) 505-5953
Mailing address
129 NIMROD DR, CONCORD, MA 01742-1646
(978) 369-0035
(978) 369-0035
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1653
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LD0169
BCBSMA LDN ANCILLARY PROV
MA
Enumeration date
05/31/2005
Last updated
10/30/2008
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