Healthcare Provider Details

I. General information

NPI: 1821571886
Provider Name (Legal Business Name): THANDIWE DHLIWAYO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 FRESH RIVER RD
EPPING NH
03042-2222
US

IV. Provider business mailing address

31 FRESH RIVER RD
EPPING NH
03042-2222
US

V. Phone/Fax

Practice location:
  • Phone: 603-842-7760
  • Fax: 844-222-8864
Mailing address:
  • Phone: 603-842-7760
  • Fax: 844-222-8864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number069915-21
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number069915-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: