Healthcare Provider Details

I. General information

NPI: 1205869591
Provider Name (Legal Business Name): MAUREEN T QUIGLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR GENERAL SURGERY CLINIC 4C
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR GENERAL SURGERY CLINIC 4C
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-7913
  • Fax: 603-650-8030
Mailing address:
  • Phone: 603-650-7913
  • Fax: 603-650-8030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number024607-23-03
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: