Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 947 | MA |
NPI | 1316029994 |
---|---|
Provider Name | Dr. Lorrette Alice Marion |
First Address | West Springfield, MA 01089-2801 |
Second Address | West Springfield, MA 01089-2801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 08/07/2007 |