Healthcare Provider Details

I. General information

NPI: 1124898788
Provider Name (Legal Business Name): ELIZABETH NAULT MS/ NUTRITIONIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 MALLARD PT
MERRIMACK NH
03054-3334
US

IV. Provider business mailing address

31 MALLARD PT
MERRIMACK NH
03054-3334
US

V. Phone/Fax

Practice location:
  • Phone: 603-486-2810
  • Fax:
Mailing address:
  • Phone: 603-486-2810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: