=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326116690
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA BRADLEY MURRAY-DERR R.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2006
-----------------------------------------------------
Last Update Date | 02/28/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 ELIJAH HILL LN
-----------------------------------------------------
City | LONDONDERRY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03053-3958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-883-0016
-----------------------------------------------------
Fax | 603-883-0016
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 ELIJAH HILL LN
-----------------------------------------------------
City | LONDONDERRY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03053-3958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-883-0016
-----------------------------------------------------
Fax | 603-883-0016
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 72
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133N00000X
-----------------------------------------------------
Taxonomy Name | Nutritionist
-----------------------------------------------------
License Number | 72
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------