Healthcare Provider Details

I. General information

NPI: 1104538040
Provider Name (Legal Business Name): MAYA BEEGAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAYA BEEGAN RN

II. Dates (important events)

Enumeration Date: 12/22/2022
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17A TATRO RD STE 201
GOFFSTOWN NH
03045-2370
US

IV. Provider business mailing address

486 WHITTINGTON ST
MANCHESTER NH
03104-6493
US

V. Phone/Fax

Practice location:
  • Phone: 603-314-4500
  • Fax:
Mailing address:
  • Phone: 603-321-3043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number071627-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number071627-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: