Healthcare Provider Details

I. General information

NPI: 1821084823
Provider Name (Legal Business Name): NANCY ELIZABETH DIRUBBO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 UNION AVE
LACONIA NH
03246-2817
US

IV. Provider business mailing address

501 UNION AVE
LACONIA NH
03246-2817
US

V. Phone/Fax

Practice location:
  • Phone: 603-528-4304
  • Fax: 603-528-8077
Mailing address:
  • Phone: 603-528-4304
  • Fax: 603-528-8077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0221892303
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: