Healthcare Provider Details

I. General information

NPI: 1528421765
Provider Name (Legal Business Name): SERENA SNOW COPPOLA DNP, APRN, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SERENA SNOW LARIVIERE DNP, APRN, CRNA

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR ANESTHESIOLOGY
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-5000
  • Fax:
Mailing address:
  • Phone: 603-650-5922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number114612-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: