Facts
- Status
- A
- Credential
- OTR
- Type
- Individual
- Enumeration date
- 2018-03-14
- Last updated
- 2018-03-14
Specialties
Licenses
- License NH
- 1545
Location
- Practice location
- 144 NH ROUTE 175A
- City
- HOLDERNESS NH
- Postal code
- 032455055
- Phone
- 603-481-0055
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.