Provider Demographics
NPI:1285783803
Name:CORNELL, JESSAMY WOOD (RDN, LD, CDE)
Entity type:Individual
Prefix:
First Name:JESSAMY
Middle Name:WOOD
Last Name:CORNELL
Suffix:
Gender:F
Credentials:RDN, LD, CDE
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 1555
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03894-1555
Mailing Address - Country:US
Mailing Address - Phone:603-498-4862
Mailing Address - Fax:
Practice Address - Street 1:240 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4411
Practice Address - Country:US
Practice Address - Phone:603-569-7549
Practice Address - Fax:603-515-2085
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH346133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered