Provider Demographics
NPI:1851440390
Name:SCOTT, MICHELLE IVES (RD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:IVES
Last Name:SCOTT
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 1:1245 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1308
Mailing Address - Country:US
Mailing Address - Phone:603-878-1680
Mailing Address - Fax:
Practice Address - Street 1:632 SAND PIT RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:NH
Practice Address - Zip Code:03048-4304
Practice Address - Country:US
Practice Address - Phone:603-878-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH343133VN1004X
VA190 10600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Not Answered174400000XOther Service ProvidersSpecialist