Healthcare Provider Details

I. General information

NPI: 1366086936
Provider Name (Legal Business Name): COLLEEN ELIZABETH SLAWIAK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN ELIZABETH HENRY PA-C

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 PLEASANT ST BLDG WEST
CONCORD NH
03301-2548
US

IV. Provider business mailing address

250 PLEASANT ST
CONCORD NH
03301-2598
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-3388
  • Fax: 603-227-7536
Mailing address:
  • Phone: 603-227-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA7313
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2881
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: