Healthcare Provider Details

I. General information

NPI: 1891232401
Provider Name (Legal Business Name): ERIN STORM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2017
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 ALLEN ST
HANOVER NH
03755-2065
US

IV. Provider business mailing address

7 ALLEN ST
HANOVER NH
03755-2065
US

V. Phone/Fax

Practice location:
  • Phone: 603-738-1164
  • Fax: 415-252-7176
Mailing address:
  • Phone: 603-738-1164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number020538
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1965
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: