Healthcare Provider Details

I. General information

NPI: 1275873929
Provider Name (Legal Business Name): JAMIE L LAROCHE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE LEE HANEY RN

II. Dates (important events)

Enumeration Date: 02/18/2013
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 HIGHLAND ST
LACONIA NH
03246-3235
US

IV. Provider business mailing address

PO BOX 678
LACONIA NH
03247-0678
US

V. Phone/Fax

Practice location:
  • Phone: 603-527-2819
  • Fax: 603-527-2984
Mailing address:
  • Phone: 603-524-3211
  • Fax: 603-527-7164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number051916-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: