Healthcare Provider Details

I. General information

NPI: 1164861126
Provider Name (Legal Business Name): MELISSA HARLOW APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2013
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CHURCH ST
LACONIA NH
03246-3432
US

IV. Provider business mailing address

43 MAMMOTH ROAD
LONDONDERRY NH
03053
US

V. Phone/Fax

Practice location:
  • Phone: 603-524-1100
  • Fax:
Mailing address:
  • Phone: 603-986-8446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number064439-21
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number064439-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: