Healthcare Provider Details

I. General information

NPI: 1427846781
Provider Name (Legal Business Name): BRETT WAYNE MDA, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 RIVERSIDE ST STE 202
NASHUA NH
03062-1383
US

IV. Provider business mailing address

17 RIVERSIDE ST STE 202
NASHUA NH
03062-1383
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1973
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: