Healthcare Provider Details

I. General information

NPI: 1932435286
Provider Name (Legal Business Name): KRISTY MAY NADEAU BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 STATE ST # 2
BERLIN NH
03570-1839
US

IV. Provider business mailing address

87 STATE ST # 2
BERLIN NH
03570-1839
US

V. Phone/Fax

Practice location:
  • Phone: 603-915-1030
  • Fax:
Mailing address:
  • Phone: 603-915-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number04085000
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: