Healthcare Provider Details

I. General information

NPI: 1902446461
Provider Name (Legal Business Name): BONNIE D ENSINGER MS,RDN,LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MCGREGOR ST
MANCHESTER NH
03102-3770
US

IV. Provider business mailing address

100 MCGREGOR ST
MANCHESTER NH
03102-3730
US

V. Phone/Fax

Practice location:
  • Phone: 603-663-6985
  • Fax:
Mailing address:
  • Phone: 603-663-6985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number156
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: