Healthcare Provider Details

I. General information

NPI: 1932193828
Provider Name (Legal Business Name): STACEY L RHYNE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 CENTRAL AVE # LEVEL1
DOVER NH
03820-2526
US

IV. Provider business mailing address

789 CENTRAL AVE
DOVER NH
03820-2526
US

V. Phone/Fax

Practice location:
  • Phone: 603-610-8094
  • Fax:
Mailing address:
  • Phone: 603-692-6676
  • Fax: 603-692-0919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number037187-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: