Healthcare Provider Details

I. General information

NPI: 1124891601
Provider Name (Legal Business Name): CULTIVATE NUTRITION RDN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 STUMPFIELD RD
KENSINGTON NH
03833-6812
US

IV. Provider business mailing address

20 PORTSMOUTH AVE STE 3
STRATHAM NH
03885-6528
US

V. Phone/Fax

Practice location:
  • Phone: 860-748-3757
  • Fax: 603-956-3064
Mailing address:
  • Phone: 860-748-3757
  • Fax: 603-956-3064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: ABBEY HUBBELL
Title or Position: OWNER/PRACTITIONER
Credential: RD
Phone: 860-748-3757