Healthcare Provider Details

I. General information

NPI: 1114106523
Provider Name (Legal Business Name): MARISA SMITH RD,LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1139 ROUTE 63
WESTMORELAND NH
03467
US

IV. Provider business mailing address

1139 ROUTE 63
WESTMORELAND NH
03467
US

V. Phone/Fax

Practice location:
  • Phone: 603-399-4988
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: