MEDICARE: MS. JENNY ESTELLE LOEW M.S., RD, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	402	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27Y008018NH01	OTHER	NH	ANTHEM
2	468018	OTHER	NH	TUFTS

General Provider Information

NPI Number	:	1639162878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNY ESTELLE LOEW M.S., RD, LD

Provider Business Mailing Address
First Line	:	23 STILES RD
Second Line	:	SUITE 213
City	:	SALEM
State	:	NH
Zip	:	03079-2859
Country	:	US
Telephone Number	:	603-898-9834
Fax Number	:	603-898-8253

Provider Business Practice Location Address
First Line	:	23 STILES RD
Second Line	:	SUITE 213
City	:	SALEM
State	:	NH
Zip	:	03079-2859
Country	:	US
Telephone Number	:	603-898-8934
Fax Number	:	603-898-8253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	05/05/2008

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