Healthcare Provider Details

I. General information

NPI: 1255888434
Provider Name (Legal Business Name): SOUTHERN NEW HAMPSHIRE NURSE PRACTITIONERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 LAFAYETTE RD SUITE 101
HAMPTON NH
03842-2267
US

IV. Provider business mailing address

428 LAFAYETTE RD APT 101 PO BOX 171
HAMPTON NH
03842-2268
US

V. Phone/Fax

Practice location:
  • Phone: 603-395-1724
  • Fax: 888-979-8717
Mailing address:
  • Phone: 603-395-1724
  • Fax: 888-979-8717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number046771-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number046771-23
License Number StateNH

VIII. Authorized Official

Name: MR. ROBERT E DILLON
Title or Position: NURSE PRACTITIONER/SOLE MEMBER
Credential: MS, APRN
Phone: 603-866-1881