Healthcare Provider Details

I. General information

NPI: 1538278130
Provider Name (Legal Business Name): ELIZABETH ANNE KIMTIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
LEBANON NH
03756-1000
US

IV. Provider business mailing address

ONE MEDICAL CENTER DRIVE
LEBANON NH
03756
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-4628
  • Fax: 603-650-2334
Mailing address:
  • Phone: 603-650-4628
  • Fax: 603-650-2334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number035293-23-03
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: