Provider Demographics
NPI:1306599642
Name:PELOQUIN, HEATHER L (RN, NUTRITIONIST)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:PELOQUIN
Suffix:
Gender:F
Credentials:RN, NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CHESTER ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03036-4308
Mailing Address - Country:US
Mailing Address - Phone:603-887-1966
Mailing Address - Fax:
Practice Address - Street 1:15 CHESTER ST UNIT C
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NH
Practice Address - Zip Code:03036-4308
Practice Address - Country:US
Practice Address - Phone:603-887-1966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 174H00000X
NH031735-21163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No174H00000XOther Service ProvidersHealth Educator