Provider Demographics
NPI:1649580978
Name:TAYLOR, HEATHER S (RD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:S
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:S
Other - Last Name:MACDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:707 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-3010
Mailing Address - Country:US
Mailing Address - Phone:603-264-7851
Mailing Address - Fax:603-218-6167
Practice Address - Street 1:93 S MAPLE ST
Practice Address - Street 2:C/O MERRICK SPINE CENTER
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-5749
Practice Address - Country:US
Practice Address - Phone:603-641-4800
Practice Address - Fax:603-622-3199
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0584133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered