Healthcare Provider Details

I. General information

NPI: 1689538084
Provider Name (Legal Business Name): ELIZABETH FUSCO MS, RDN, CSSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 E WHEELOCK ST
HANOVER NH
03755-1565
US

IV. Provider business mailing address

16 E WHEELOCK ST
HANOVER NH
03755-1565
US

V. Phone/Fax

Practice location:
  • Phone: 707-331-2981
  • Fax:
Mailing address:
  • Phone: 707-331-2981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number1906
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: