Healthcare Provider Details

I. General information

NPI: 1598006371
Provider Name (Legal Business Name): REMY BACAICOA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR DHMC-DEPT OF ORTHOPAEDICS
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR DHMC-DEPT OF ORTHOPAEDICS
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-5155
  • Fax:
Mailing address:
  • Phone: 603-650-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0090812
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number056713-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: