Provider Demographics
NPI:1679534739
Name:VISCO, PATRICIA (CDR)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:VISCO
Suffix:
Gender:F
Credentials:CDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03235-2026
Mailing Address - Country:US
Mailing Address - Phone:603-934-1464
Mailing Address - Fax:603-934-1464
Practice Address - Street 1:841 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NH
Practice Address - Zip Code:03235-2026
Practice Address - Country:US
Practice Address - Phone:603-934-1464
Practice Address - Fax:603-934-1464
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH337816133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHMT0092Medicare ID - Type Unspecified