Healthcare Provider Details

I. General information

NPI: 1245560077
Provider Name (Legal Business Name): PATRICIA JEAN HOLT RD/CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2009
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HITCHCOCK WAY
MANCHESTER NH
03104-4125
US

IV. Provider business mailing address

100 HITCHCOCK WAY
MANCHESTER NH
03104-4125
US

V. Phone/Fax

Practice location:
  • Phone: 603-645-6401
  • Fax: 978-469-5646
Mailing address:
  • Phone:
  • Fax: 978-469-5646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number3782
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number236
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: