Provider Demographics
NPI:1306201595
Name:MOREAU, MICHELLE EVE (RDN)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:EVE
Last Name:MOREAU
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CUTTS ST UNIT 103
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3245
Mailing Address - Country:US
Mailing Address - Phone:603-294-0462
Mailing Address - Fax:603-498-1924
Practice Address - Street 1:4 CUTTS ST UNIT 103
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3245
Practice Address - Country:US
Practice Address - Phone:603-294-0462
Practice Address - Fax:603-498-1924
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0788133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered