Provider Demographics
NPI:1811395825
Name:DONNELLY, AMY ROSE (RD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ROSE
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 PALOMINO LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6447
Mailing Address - Country:US
Mailing Address - Phone:603-518-5859
Mailing Address - Fax:
Practice Address - Street 1:80 PALOMINO LN
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6447
Practice Address - Country:US
Practice Address - Phone:603-518-5859
Practice Address - Fax:603-606-1032
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-08
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0755133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered