Active NPI
Eliane Provencher, NHP-BC
- Nutrition Education Nutritionist
- West Hartford, CT
National Provider Identifier
1174951636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutrition Education Nutritionist
- License
- RND20007152
- Practice address
- 345 N Main St
Neiha
West Hartford, CT 06117-2515 - Phone
- (860) 547-1489
- NPI assigned
- Oct 21, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutrition Education Nutritionist | 133NN1002X | RND20007152 | NV | Primary |
Addresses
Primary practice location
345 N Main St
Neiha
West Hartford, CT 06117-2515
Mailing address
21 Rockwell Rd
Stafford Springs, CT 06076-4513
Phone (860) 888-8613
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RND20007152 | NV | MD | Nutrition Education Nutritionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1382313600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1382313600000",
"number": "1174951636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 ROCKWELL RD",
"city": "STAFFORD SPRINGS",
"state": "CT",
"postal_code": "060764513",
"telephone_number": "860-888-8613"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "345 N MAIN ST",
"address_2": "NEIHA",
"city": "WEST HARTFORD",
"state": "CT",
"postal_code": "061172515",
"telephone_number": "860-547-1489"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROVENCHER",
"first_name": "ELIANE",
"credential": "NHP-BC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-10-21",
"last_updated": "2013-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "133NN1002X",
"taxonomy_group": "",
"desc": "Nutritionist, Nutrition, Education",
"state": "NV",
"license": "RND20007152",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Hartford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.