Provider Demographics
NPI:1902982911
Name:SNOW, MELISSA LEE (RD, LD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEE
Last Name:SNOW
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NEW HAMPSHIRE AVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-2904
Mailing Address - Country:US
Mailing Address - Phone:603-766-0472
Mailing Address - Fax:603-766-1966
Practice Address - Street 1:1 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-2904
Practice Address - Country:US
Practice Address - Phone:603-766-0472
Practice Address - Fax:603-766-1966
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH226133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH27Y004552NH02OtherANTHEM BCBS
NH612084OtherCIGNA-CONCORD, NH
NH2773342OtherCIGNA
NH5517713OtherAETNA
NHAA58452OtherHARVARD PILGRIM HEALTHCAR
NH612084OtherCIGNA-CONCORD, NH