Provider Demographics
NPI:1801464342
Name:MUDGETT, ALICIA F
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:F
Last Name:MUDGETT
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:PO BOX 354
Mailing Address - Street 2:
Mailing Address - City:CHOCORUA
Mailing Address - State:NH
Mailing Address - Zip Code:03817-0354
Mailing Address - Country:US
Mailing Address - Phone:207-604-0360
Mailing Address - Fax:
Practice Address - Street 1:1857 WHITE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5158
Practice Address - Country:US
Practice Address - Phone:603-730-5356
Practice Address - Fax:603-730-5477
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0573133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered