Provider Demographics
NPI:1427846781
Name:WAYNE, BRETT (MDA, RD)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:WAYNE
Suffix:
Gender:
Credentials:MDA, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 RIVERSIDE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1383
Mailing Address - Country:US
Mailing Address - Phone:603-577-5760
Mailing Address - Fax:
Practice Address - Street 1:17 RIVERSIDE ST STE 202
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-1383
Practice Address - Country:US
Practice Address - Phone:603-577-5760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1973133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered