Provider Demographics
NPI:1902826753
Name:LAVERY, AVA H (RD)
Entity Type:Individual
Prefix:MS
First Name:AVA
Middle Name:H
Last Name:LAVERY
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 1:503 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:CANDIA
Mailing Address - State:NH
Mailing Address - Zip Code:03034-2763
Mailing Address - Country:US
Mailing Address - Phone:603-483-5348
Mailing Address - Fax:
Practice Address - Street 1:718 SMYTH RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-7004
Practice Address - Country:US
Practice Address - Phone:603-624-4366
Practice Address - Fax:603-626-6557
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH614589133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH614589OtherREGISTERED DIETITIAN
NH227OtherLICENSED DIETITIAN