Provider Demographics
NPI:1700424504
Name:AVANTS, JACQUELINE (RD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:AVANTS
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 1:23 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-1417
Mailing Address - Country:US
Mailing Address - Phone:201-970-1843
Mailing Address - Fax:
Practice Address - Street 1:38 PORTSMOUTH AVE
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2106
Practice Address - Country:US
Practice Address - Phone:603-580-4476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1008133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered