Provider Demographics
NPI:1548890205
Name:HAILEY CREAN NUTRITION, LLC
Entity type:Organization
Organization Name:HAILEY CREAN NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CREAN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:617-812-3180
Mailing Address - Street 1:24 WALNUT PL
Mailing Address - Street 2:
Mailing Address - City:NEWTON HIGHLANDS
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1717
Mailing Address - Country:US
Mailing Address - Phone:617-812-3180
Mailing Address - Fax:833-898-0629
Practice Address - Street 1:24 WALNUT PL
Practice Address - Street 2:
Practice Address - City:NEWTON HIGHLANDS
Practice Address - State:MA
Practice Address - Zip Code:02461-1717
Practice Address - Country:US
Practice Address - Phone:617-812-3180
Practice Address - Fax:833-898-0629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty