Healthcare Provider Details

I. General information

NPI: 1073707121
Provider Name (Legal Business Name): MEGRETTE F FLETCHER RD LD CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGRETTE F HAMMOND MED RD CDE

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MEMBERS WAY SUITE 300
DOVER NH
03820-5933
US

IV. Provider business mailing address

789 CENTRAL AVENUE
DOVER NH
03820-2526
US

V. Phone/Fax

Practice location:
  • Phone: 603-742-7222
  • Fax: 603-740-7441
Mailing address:
  • Phone: 603-742-7222
  • Fax: 603-740-7441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number803789
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: