Healthcare Provider Details

I. General information

NPI: 1649763103
Provider Name (Legal Business Name): COMPASS FAMILY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2018
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 CENTRAL AVE STE 200
DOVER NH
03820-2506
US

IV. Provider business mailing address

835 CENTRAL AVE STE 200
DOVER NH
03820-2506
US

V. Phone/Fax

Practice location:
  • Phone: 603-749-0001
  • Fax: 603-749-1006
Mailing address:
  • Phone: 603-749-0001
  • Fax: 603-749-1006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number074094-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAURA ELIZABETH HUDSON
Title or Position: OWNER/ MANAGER/PROVIDER
Credential: FNP-C, APRN, DNP
Phone: 603-749-0001