Healthcare Provider Details

I. General information

NPI: 1437111606
Provider Name (Legal Business Name): SANDRA LA REE MOTE MS CS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MEMBERS WAY SUITE 401
DOVER NH
03820-5933
US

IV. Provider business mailing address

789 CENTRAL AVE
DOVER NH
03820-2526
US

V. Phone/Fax

Practice location:
  • Phone: 603-742-9200
  • Fax: 603-742-4605
Mailing address:
  • Phone: 603-742-9200
  • Fax: 603-742-4605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number589
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: