Healthcare Provider Details

I. General information

NPI: 1205933983
Provider Name (Legal Business Name): COREY A PIPER APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COLONIAL POPLIN NURSING HOME 442 MAIN ST
FREMONT NH
03044-3434
US

IV. Provider business mailing address

32 BROWN AVE
SANDOWN NH
03873-2450
US

V. Phone/Fax

Practice location:
  • Phone: 603-895-3126
  • Fax: 603-895-3662
Mailing address:
  • Phone: 603-978-5999
  • Fax: 603-887-2044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number036290-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: