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General NPI Number Information
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NPI Number | 1104045616
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Entity Type | Individual
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Provider Name | BARBARA J WIENTZEN-DAGENAIS RD,CDE,BC-ADM
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Gender | Female
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 250 PLEASANT ST
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City | CONCORD
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State | NH
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Zip | 03301-7559
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Country | US
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Telephone | 603-227-7000
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Fax | 603-227-7516
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Provider Business Mailing Address
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Address Line | 6 BUTTRICK RD STE 102
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City | LONDONDERRY
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State | NH
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Zip | 03053-3417
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Country | US
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Telephone | 603-537-1317
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Fax | 603-845-5182
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 87
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License Number State | NH
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