Provider Demographics
NPI:1811786288
Name:PETRI, BENJIMAN JAKOB (MS, RD)
Entity type:Individual
Prefix:MR
First Name:BENJIMAN
Middle Name:JAKOB
Last Name:PETRI
Suffix:
Gender:
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CRANLEIGH MEWS
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-1529
Mailing Address - Country:US
Mailing Address - Phone:618-823-2280
Mailing Address - Fax:618-823-2280
Practice Address - Street 1:36 CLINTON ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2359
Practice Address - Country:US
Practice Address - Phone:603-271-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1852133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered