Provider Demographics
NPI:1447720339
Name:GIRARD, THERESA ANDERSON
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ANDERSON
Last Name:GIRARD
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 1163
Mailing Address - Street 2:
Mailing Address - City:STRATHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03885-1163
Mailing Address - Country:US
Mailing Address - Phone:844-482-7296
Mailing Address - Fax:844-252-2008
Practice Address - Street 1:408 LAFAYETTE RD # 3
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-2222
Practice Address - Country:US
Practice Address - Phone:877-667-7282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0858133V00000X
MA1046133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty