Healthcare Provider Details

I. General information

NPI: 1124208665
Provider Name (Legal Business Name): ALICIA PRZYDZIELSKI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 OLD ETNA RD DH DEPARTMENT OF FAMILY MEDICINE
LEBANON NH
03766
US

IV. Provider business mailing address

1 MEDICAL CENTER DR DHMC DEPARTMENT OF FAMILY MEDICINE
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-4000
  • Fax: 603-650-4190
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number058484-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: