Provider Demographics
NPI:1932435286
Name:NADEAU, KRISTY MAY (BS)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:MAY
Last Name:NADEAU
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 STATE ST # 2
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-1839
Mailing Address - Country:US
Mailing Address - Phone:603-915-1030
Mailing Address - Fax:
Practice Address - Street 1:87 STATE ST # 2
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-1839
Practice Address - Country:US
Practice Address - Phone:603-915-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
04085000133N00000X
133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionist