Healthcare Provider Details

I. General information

NPI: 1265782114
Provider Name (Legal Business Name): MARIAH MCHOSE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N MAIN ST STE 1A
LISBON NH
03585-6600
US

IV. Provider business mailing address

249 PAINE RD
EASTON NH
03580-5401
US

V. Phone/Fax

Practice location:
  • Phone: 802-588-0375
  • Fax: 888-453-0809
Mailing address:
  • Phone: 603-616-7026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number055115-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number055115-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: