Healthcare Provider Details

I. General information

NPI: 1184361446
Provider Name (Legal Business Name): JASHAN REET STICKLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JASHAN REET JAMMU MD

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date: 02/16/2023
Reactivation Date: 03/08/2023

III. Provider practice location address

1 MEDICAL CENTER DR
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-653-9121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: