Healthcare Provider Details

I. General information

NPI: 1043784101
Provider Name (Legal Business Name): PATRICIA B. MURRAY-DERR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ELIJAH HILL LN
LONDONDERRY NH
03053-3958
US

IV. Provider business mailing address

10 ELIJAH HILL LN
LONDONDERRY NH
03053-3958
US

V. Phone/Fax

Practice location:
  • Phone: 603-883-0016
  • Fax:
Mailing address:
  • Phone: 603-883-0016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA MURRAY-DERR
Title or Position: OWNER
Credential: RD
Phone: 603-883-0016