Healthcare Provider Details

I. General information

NPI: 1881036325
Provider Name (Legal Business Name): LORETTA THERESIA MACEY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 PONEMAH RD SUITE 9
AMHERST NH
03031-2834
US

IV. Provider business mailing address

109 PONEMAH ROAD SUITE 9
AMHERST NH
03031
US

V. Phone/Fax

Practice location:
  • Phone: 603-249-5771
  • Fax:
Mailing address:
  • Phone: 603-249-5771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number028745-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: