Healthcare Provider Details

I. General information

NPI: 1346966579
Provider Name (Legal Business Name): SAMANTHA BONNIER RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HITCHCOCK WAY
MANCHESTER NH
03104-4125
US

IV. Provider business mailing address

1800 ORLEANS ST BLOOMBERG 9306
BALTIMORE MD
21287-0010
US

V. Phone/Fax

Practice location:
  • Phone: 603-695-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDX5695
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1431
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: