Provider Demographics
NPI:1487070447
Name:PHELAN, MEAGAN (RD)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:PHELAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:MEAGAN
Other - Middle Name:
Other - Last Name:DIVITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:39 BROWN HILL RD
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-4805
Mailing Address - Country:US
Mailing Address - Phone:603-393-3896
Mailing Address - Fax:603-393-3896
Practice Address - Street 1:700 2ND ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-8100
Practice Address - Country:US
Practice Address - Phone:603-393-3896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0798133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered