Healthcare Provider Details

I. General information

NPI: 1881741171
Provider Name (Legal Business Name): AMBER L PORTER OTR, FNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER P MERRILL APRN

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 CUMMINGS ROAD
HANOVER NH
03755
US

IV. Provider business mailing address

67 CUMMINGS ROAD
HANOVER NH
03755
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-8123
  • Fax:
Mailing address:
  • Phone: 603-650-8123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number062578-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT1052
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: