Healthcare Provider Details

I. General information

NPI: 1548436876
Provider Name (Legal Business Name): KRISTA IUZZOLINO GOULD N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTA ELIZABETH IUZZOLINO N.P.

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 OLD ETNA RD
LEBANON NH
03766-1937
US

IV. Provider business mailing address

27 SUMMER ST
LEBANON NH
03766-1025
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-5000
  • Fax:
Mailing address:
  • Phone: 603-727-6121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number265943
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0062966
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number085701-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: