Provider Demographics
NPI:1407570302
Name:MYERS, SAMANTHA NAOMI (RDN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:NAOMI
Last Name:MYERS
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 1:326 ELM ST APT 1
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-2614
Mailing Address - Country:US
Mailing Address - Phone:339-440-3013
Mailing Address - Fax:
Practice Address - Street 1:326 ELM ST APT 1
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-2614
Practice Address - Country:US
Practice Address - Phone:339-440-3013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
NH86175709133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered