Provider Demographics
NPI:1477329472
Name:SENIOR, ASTRID ELISABETH
Entity Type:Individual
Prefix:
First Name:ASTRID
Middle Name:ELISABETH
Last Name:SENIOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BULLARD DR
Mailing Address - Street 2:
Mailing Address - City:LYNDEBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03082-6424
Mailing Address - Country:US
Mailing Address - Phone:408-500-8982
Mailing Address - Fax:
Practice Address - Street 1:120 BULLARD DR
Practice Address - Street 2:
Practice Address - City:LYNDEBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03082-6424
Practice Address - Country:US
Practice Address - Phone:408-500-8982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239364104133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist