Provider Demographics
NPI:1174364855
Name:BARTLES, MOLLIE (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:BARTLES
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MARGARET ST APT D
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2049
Mailing Address - Country:US
Mailing Address - Phone:860-806-3531
Mailing Address - Fax:
Practice Address - Street 1:105 MARGARET ST APT D
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2049
Practice Address - Country:US
Practice Address - Phone:860-806-3531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI1978133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered