Provider Demographics
NPI:1609302785
Name:FARWELL, MELANIE (RD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:FARWELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 OLD CHESHAM RD
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03455-8100
Mailing Address - Country:US
Mailing Address - Phone:603-313-5713
Mailing Address - Fax:
Practice Address - Street 1:508 OLD CHESHAM RD
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03455-8100
Practice Address - Country:US
Practice Address - Phone:603-313-5713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0513133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered