Provider Demographics
NPI:1982821138
Name:MUMFORD, ERICA ALEXIS SCHULTZE (RD, LD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:ALEXIS SCHULTZE
Last Name:MUMFORD
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 PALOMINO LN STE 501
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6448
Mailing Address - Country:US
Mailing Address - Phone:603-557-8047
Mailing Address - Fax:
Practice Address - Street 1:82 PALOMINO LN STE 501
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6448
Practice Address - Country:US
Practice Address - Phone:603-557-8047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH224133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCMT0637OtherMNT NUMBER