Healthcare Provider Details

I. General information

NPI: 1336791110
Provider Name (Legal Business Name): BENJAMIN M TRETTER MSN, PMH-NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BUCK RD STE JK
HANOVER NH
03755-2715
US

IV. Provider business mailing address

35 NEWPORT RD
NEW LONDON NH
03257-5413
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number115057-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: