Provider Demographics
NPI:1043213903
Name:MILLS, MARILYN M (RD, CDE)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:M
Last Name:MILLS
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 ROUTE 101
Mailing Address - Street 2:STE 10
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-5031
Mailing Address - Country:US
Mailing Address - Phone:603-472-2846
Mailing Address - Fax:603-472-2872
Practice Address - Street 1:360 ROUTE 101
Practice Address - Street 2:STE 10
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-5031
Practice Address - Country:US
Practice Address - Phone:603-472-2846
Practice Address - Fax:603-472-2872
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH200133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHMT0497Medicare ID - Type UnspecifiedPART B