Provider Demographics
NPI:1114106523
Name:SMITH, MARISA (RD,LD)
Entity Type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 ROUTE 63
Mailing Address - Street 2:
Mailing Address - City:WESTMORELAND
Mailing Address - State:NH
Mailing Address - Zip Code:03467
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1139 ROUTE 63
Practice Address - Street 2:
Practice Address - City:WESTMORELAND
Practice Address - State:NH
Practice Address - Zip Code:03467
Practice Address - Country:US
Practice Address - Phone:603-399-4988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric