Healthcare Provider Details

I. General information

NPI: 1124308523
Provider Name (Legal Business Name): CARLY A MARQUIS HENSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLY MARQUIS

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PLEASANT ST
CONCORD NH
03301-7539
US

IV. Provider business mailing address

250 PLEASANT ST
CONCORD NH
03301-7559
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-0123
  • Fax: 603-227-7591
Mailing address:
  • Phone: 603-225-0123
  • Fax: 603-227-7591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number28185426A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number073463-23
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704309057
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: