Healthcare Provider Details

I. General information

NPI: 1134055502
Provider Name (Legal Business Name): TWIN STATE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SOUTH ST STE 3B
HANOVER NH
03755-2163
US

IV. Provider business mailing address

12 SOUTH ST STE 3B
HANOVER NH
03755-2163
US

V. Phone/Fax

Practice location:
  • Phone: 603-359-3508
  • Fax: 603-359-3508
Mailing address:
  • Phone: 603-359-3508
  • Fax: 603-359-3508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KERRY O'HARA
Title or Position: NURSE PRACTITIONER
Credential: DNP, AGNP-C
Phone: 603-359-3508