Healthcare Provider Details

I. General information

NPI: 1164481396
Provider Name (Legal Business Name): JACQUELINE L MEADOWS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 EASTMAN AVE
BEDFORD NH
03110-6744
US

IV. Provider business mailing address

67 NORMA DR
NASHUA NH
03062-1348
US

V. Phone/Fax

Practice location:
  • Phone: 603-577-3003
  • Fax: 603-577-3331
Mailing address:
  • Phone: 603-718-8728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number177806
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0312952303
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: