Provider Demographics
NPI:1255938825
Name:VAN GOMBOS, MICHELLE (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:VAN GOMBOS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 ALDERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STRATHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03885-4205
Mailing Address - Country:US
Mailing Address - Phone:603-247-1013
Mailing Address - Fax:
Practice Address - Street 1:15 OLD ROLLINSFORD RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2868
Practice Address - Country:US
Practice Address - Phone:603-740-2647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered