Provider Demographics
NPI:1104092923
Name:INZER, SANDRA (RDH MS RD LD CPHDH)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:INZER
Suffix:
Gender:F
Credentials:RDH MS RD LD CPHDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 LILY POND RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03825-5912
Mailing Address - Country:US
Mailing Address - Phone:603-664-5876
Mailing Address - Fax:603-332-5228
Practice Address - Street 1:61 LILY POND RD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:NH
Practice Address - Zip Code:03825-5912
Practice Address - Country:US
Practice Address - Phone:603-664-5876
Practice Address - Fax:603-332-5228
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH918124Q00000X
NH352133V00000X
ME2283124Q00000X
MA6712124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered