Healthcare Provider Details

I. General information

NPI: 1396777553
Provider Name (Legal Business Name): LUCY K WHITE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 OLD ROLLINSFORD RD BUILDING 102
DOVER NH
03820-2868
US

IV. Provider business mailing address

789 CENTRAL AVE
DOVER NH
03820-2526
US

V. Phone/Fax

Practice location:
  • Phone: 603-749-4963
  • Fax:
Mailing address:
  • Phone: 603-749-4963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number045645-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: