Provider Demographics
NPI:1831313303
Name:STEPHENS, AMIE L (RD)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:L
Last Name:STEPHENS
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 1:18 FOUNDRY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5421
Mailing Address - Country:US
Mailing Address - Phone:603-230-5636
Mailing Address - Fax:603-227-7584
Practice Address - Street 1:18 FOUNDRY ST STE 101
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5421
Practice Address - Country:US
Practice Address - Phone:603-230-5636
Practice Address - Fax:603-227-7584
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH312133V00000X
NH919596133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHAA30207OtherHARVARD PILGRIM ID #
NH30859YOtherANTHEM BCBS ID #
NHAA30207OtherHARVARD PILGRIM ID #