Healthcare Provider Details

I. General information

NPI: 1083012405
Provider Name (Legal Business Name): EMILY THOMPSON RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY PURMORT

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 CENTRAL AVE
DOVER NH
03820-2526
US

IV. Provider business mailing address

789 CENTRAL AVE
DOVER NH
03820-2526
US

V. Phone/Fax

Practice location:
  • Phone: 603-610-8095
  • Fax:
Mailing address:
  • Phone: 603-610-8095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3461
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0653
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: