Healthcare Provider Details

I. General information

NPI: 1891505418
Provider Name (Legal Business Name): COLLEEN MARGUERITE PACKARD MS, MPH, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 OLD WEST HOPKINTON RD
HENNIKER NH
03242-4136
US

IV. Provider business mailing address

128 ROUTE 27
RAYMOND NH
03077-1230
US

V. Phone/Fax

Practice location:
  • Phone: 774-678-9708
  • Fax:
Mailing address:
  • Phone: 603-895-3351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111588-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number111588-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: