Healthcare Provider Details

I. General information

NPI: 1891973269
Provider Name (Legal Business Name): DC WHITFIELD APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: D.C. WHITFIELD

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 05/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W PARK ST STE 418
LEBANON NH
03766
US

IV. Provider business mailing address

20 W PARK ST STE 418
LEBANON NH
03766-1322
US

V. Phone/Fax

Practice location:
  • Phone: 802-526-2220
  • Fax:
Mailing address:
  • Phone: 802-526-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number056284-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: