Healthcare Provider Details

I. General information

NPI: 1568421006
Provider Name (Legal Business Name): JUDY A MISIASZEK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 11/08/2011
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 TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number027211-23-05
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number92779
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: