Healthcare Provider Details

I. General information

NPI: 1245875129
Provider Name (Legal Business Name): LAUREN LYNN SKUSEVICH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 LOUDON RD
CONCORD NH
03301-5300
US

IV. Provider business mailing address

111 NEW HAMPSHIRE AVE
PORTSMOUTH NH
03801-2864
US

V. Phone/Fax

Practice location:
  • Phone: 603-226-9000
  • Fax:
Mailing address:
  • Phone: 603-226-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number070770-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: