Provider Demographics
NPI:1104045616
Name:WIENTZEN-DAGENAIS, BARBARA J (RD,CDE,BC-ADM)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:J
Last Name:WIENTZEN-DAGENAIS
Suffix:
Gender:F
Credentials:RD,CDE,BC-ADM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6 BUTTRICK RD
Mailing Address - Street 2:STE 102
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3417
Mailing Address - Country:US
Mailing Address - Phone:603-537-1317
Mailing Address - Fax:603-845-5182
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7559
Practice Address - Country:US
Practice Address - Phone:603-227-7000
Practice Address - Fax:603-227-7516
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH87133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHWIMT0252OtherMEDICAL NUTRITION THERAPY