Healthcare Provider Details

I. General information

NPI: 1477569234
Provider Name (Legal Business Name): NEW CREATION HEALING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 ROUTE 125
KINGSTON NH
03848-3535
US

IV. Provider business mailing address

80 ROUTE 125
KINGSTON NH
03848-3535
US

V. Phone/Fax

Practice location:
  • Phone: 603-642-6700
  • Fax: 603-642-6701
Mailing address:
  • Phone: 603-642-6700
  • Fax: 603-642-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY G PEARSON
Title or Position: COO/PHYSICIAN
Credential: DO
Phone: 603-642-6700