Healthcare Provider Details

I. General information

NPI: 1720859788
Provider Name (Legal Business Name): STUART EYNON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 CLINTON ST
CONCORD NH
03301-2359
US

IV. Provider business mailing address

36 CLINTON ST
CONCORD NH
03301-2359
US

V. Phone/Fax

Practice location:
  • Phone: 603-271-5300
  • Fax:
Mailing address:
  • Phone: 603-271-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN.1667128
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number093241-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: