Healthcare Provider Details

I. General information

NPI: 1639807639
Provider Name (Legal Business Name): VALERIE LYNN WOICIECHOWSKI HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 MARLBORO ST
KEENE NH
03431-4049
US

IV. Provider business mailing address

640 MARLBORO ST
KEENE NH
03431-4049
US

V. Phone/Fax

Practice location:
  • Phone: 603-352-0637
  • Fax:
Mailing address:
  • Phone: 603-352-0637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1136
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: