Healthcare Provider Details

I. General information

NPI: 1922552835
Provider Name (Legal Business Name): CASSANDRA LYNN TUCKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSANDRA LYNN ROCHAY RN

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 ROBERTS RD
CANAAN NH
03741-7644
US

IV. Provider business mailing address

9 HANOVER ST STE 2
LEBANON NH
03766-1312
US

V. Phone/Fax

Practice location:
  • Phone: 603-934-1464
  • Fax:
Mailing address:
  • Phone: 603-448-0126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number073453-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: