Healthcare Provider Details

I. General information

NPI: 1558142034
Provider Name (Legal Business Name): WHITNEY GIAUQUE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 HEBRON AVE STE 107
GLASTONBURY CT
06033-5003
US

IV. Provider business mailing address

987 UNION ST APT A
MANCHESTER NH
03104-2540
US

V. Phone/Fax

Practice location:
  • Phone: 860-657-3376
  • Fax:
Mailing address:
  • Phone: 330-464-1551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number070834-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: