Healthcare Provider Details

I. General information

NPI: 1467757047
Provider Name (Legal Business Name): JENNA MARIE ASHBY PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PLEASANT ST
CONCORD NH
03301-7539
US

IV. Provider business mailing address

200 TECHNOLOGY DR
HOOKSETT NH
03106-2504
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-2556
  • Fax: 603-226-5821
Mailing address:
  • Phone: 603-622-6484
  • Fax: 603-647-8593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: