Healthcare Provider Details

I. General information

NPI: 1740468222
Provider Name (Legal Business Name): STEPHANIE ROSE CARSON BSCN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 ROPE FERRY RD
HANOVER NH
03755-1404
US

IV. Provider business mailing address

135 DRUM HELLER RD
SHARON VT
05065-6650
US

V. Phone/Fax

Practice location:
  • Phone: 603-646-9440
  • Fax:
Mailing address:
  • Phone: 802-763-2061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number044172-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: