Provider Demographics
NPI:1730817131
Name:YACOVELLI, COURTNEY (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:YACOVELLI
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 CLINTON ST UNIT 124
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2278
Mailing Address - Country:US
Mailing Address - Phone:603-662-2367
Mailing Address - Fax:
Practice Address - Street 1:105 LOUDON RD BLDG 2
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5601
Practice Address - Country:US
Practice Address - Phone:603-715-5150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1352133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered