Provider Demographics
NPI:1114315967
Name:MOUNTJOY, KAREN (MED, RD, LD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MOUNTJOY
Suffix:
Gender:F
Credentials:MED, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5025
Mailing Address - Country:US
Mailing Address - Phone:603-674-2479
Mailing Address - Fax:
Practice Address - Street 1:62 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5025
Practice Address - Country:US
Practice Address - Phone:603-674-2479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0728133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered