Provider Demographics
NPI:1609166107
Name:BEAUDOIN, TINA (ND)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:BEAUDOIN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 BAY ST STE 1
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-3005
Mailing Address - Country:US
Mailing Address - Phone:603-262-1545
Mailing Address - Fax:603-260-1052
Practice Address - Street 1:53 BAY ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3005
Practice Address - Country:US
Practice Address - Phone:603-260-1545
Practice Address - Fax:603-260-1052
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH84175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath