Healthcare Provider Details

I. General information

NPI: 1306505094
Provider Name (Legal Business Name): NIGHTWATER HEALTH OF NEW HAMPSHIRE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 12/03/2022
Certification Date: 12/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 WATER ST STE 3
EXETER NH
03833-2456
US

IV. Provider business mailing address

111 WATER ST STE 4
EXETER NH
03833-2456
US

V. Phone/Fax

Practice location:
  • Phone: 603-247-5442
  • Fax: 504-617-6371
Mailing address:
  • Phone: 603-247-5442
  • Fax: 504-617-6371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL IKEMIRE
Title or Position: CEO
Credential: MD
Phone: 603-247-5442