Healthcare Provider Details

I. General information

NPI: 1427541069
Provider Name (Legal Business Name): LAUREN B GIBBONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 PLEASANT ST STE G100
CONCORD NH
03301-2588
US

IV. Provider business mailing address

250 PLEASANT ST
CONCORD NH
03301-2598
US

V. Phone/Fax

Practice location:
  • Phone: 603-230-1970
  • Fax: 603-227-7573
Mailing address:
  • Phone: 603-227-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberPA6498
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: