Provider Demographics
NPI:1932571197
Name:MONROE, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MONROE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 S RIVER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6927
Mailing Address - Country:US
Mailing Address - Phone:603-647-0494
Mailing Address - Fax:603-647-0493
Practice Address - Street 1:160 S RIVER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6927
Practice Address - Country:US
Practice Address - Phone:603-647-0494
Practice Address - Fax:603-647-0493
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0783133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered