Provider Demographics
NPI:1750613881
Name:STOCKWELL, DEAN A
Entity type:Individual
Prefix:MR
First Name:DEAN
Middle Name:A
Last Name:STOCKWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 DIAMOND POND RD
Mailing Address - Street 2:
Mailing Address - City:COLEBROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03576-3513
Mailing Address - Country:US
Mailing Address - Phone:603-237-5303
Mailing Address - Fax:
Practice Address - Street 1:457 DIAMOND POND RD
Practice Address - Street 2:
Practice Address - City:COLEBROOK
Practice Address - State:NH
Practice Address - Zip Code:03576-3513
Practice Address - Country:US
Practice Address - Phone:603-237-5303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist