Healthcare Provider Details

I. General information

NPI: 1073642435
Provider Name (Legal Business Name): JULIE ANN LAVOIE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 PROSPECT ST
NASHUA NH
03060-3925
US

IV. Provider business mailing address

1 CLEARWATER LN
MERRIMACK NH
03054-4059
US

V. Phone/Fax

Practice location:
  • Phone: 603-577-5760
  • Fax:
Mailing address:
  • Phone: 603-429-4296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number75
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: