Healthcare Provider Details

I. General information

NPI: 1861938409
Provider Name (Legal Business Name): COURTNEY VORACHAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2017
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 ROBERTS RD
CANAAN NH
03741-7644
US

IV. Provider business mailing address

44 ROBERTS RD
CANAAN NH
03741-7644
US

V. Phone/Fax

Practice location:
  • Phone: 603-523-8804
  • Fax: 603-523-8804
Mailing address:
  • Phone: 603-523-8804
  • Fax: 603-523-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: