Healthcare Provider Details

I. General information

NPI: 1508879800
Provider Name (Legal Business Name): DONNA ANN PRIMERA NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 FRONT ST UNIT 100
EXETER NH
03833-2727
US

IV. Provider business mailing address

24 FRONT ST UNIT 100
EXETER NH
03833-2727
US

V. Phone/Fax

Practice location:
  • Phone: 603-689-7890
  • Fax:
Mailing address:
  • Phone: 603-689-7890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberUP003412B
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number070424-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: