Healthcare Provider Details

I. General information

NPI: 1649355009
Provider Name (Legal Business Name): NICOLE PATRICIA BETTENCOURT AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE DREYER

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 PLEASANT ST STE 2
CONCORD NH
03301-2952
US

IV. Provider business mailing address

194 PLEASANT ST STE 2
CONCORD NH
03301-2952
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-2353
  • Fax: 603-226-0727
Mailing address:
  • Phone: 603-224-2353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA348
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: