Healthcare Provider Details

I. General information

NPI: 1164881157
Provider Name (Legal Business Name): MARYLEE VERDI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 ROPE FERRY RD
HANOVER NH
03755-1421
US

IV. Provider business mailing address

35 NEWPORT RD
NEW LONDON NH
03257-5413
US

V. Phone/Fax

Practice location:
  • Phone: 603-646-9400
  • Fax:
Mailing address:
  • Phone: 603-865-1321
  • Fax: 603-865-1327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number054700-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number054700-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: