Provider Demographics
NPI:1871061853
Name:FAHEY, LOIS ANN (RD)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:ANN
Last Name:FAHEY
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 1:20 PEPIN DR
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-4420
Mailing Address - Country:US
Mailing Address - Phone:603-226-9427
Mailing Address - Fax:
Practice Address - Street 1:20 PEPIN DRIVE
Practice Address - Street 2:
Practice Address - City:BOW
Practice Address - State:NH
Practice Address - Zip Code:03304
Practice Address - Country:US
Practice Address - Phone:603-226-9427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH228133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered