Provider Demographics
NPI:1740069384
Name:HAGSTOZ, ASHA (RD, CC)
Entity type:Individual
Prefix:
First Name:ASHA
Middle Name:
Last Name:HAGSTOZ
Suffix:
Gender:F
Credentials:RD, CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:SANDOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03873-2219
Mailing Address - Country:US
Mailing Address - Phone:603-887-3667
Mailing Address - Fax:
Practice Address - Street 1:58 PHILLIPS RD
Practice Address - Street 2:
Practice Address - City:SANDOWN
Practice Address - State:NH
Practice Address - Zip Code:03873-2219
Practice Address - Country:US
Practice Address - Phone:603-887-3667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1146133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty