Provider Demographics
NPI:1437391307
Name:PELLEGRINO, AUDREY JEAN (MED, MHN,CNW)
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:JEAN
Last Name:PELLEGRINO
Suffix:
Gender:F
Credentials:MED, MHN,CNW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 LITTLEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:NH
Mailing Address - Zip Code:03230-4308
Mailing Address - Country:US
Mailing Address - Phone:603-768-3214
Mailing Address - Fax:
Practice Address - Street 1:177 LITTLEFIELD RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:NH
Practice Address - Zip Code:03230-4308
Practice Address - Country:US
Practice Address - Phone:603-768-3214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist