Healthcare Provider Details

I. General information

NPI: 1629205703
Provider Name (Legal Business Name): WHITE MOUNTAIN FAMILY HEALTHCARE LITTLETON INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 SAINT JOHNSBURY RD SUITE K
LITTLETON NH
03561-3437
US

IV. Provider business mailing address

580 SAINT JOHNSBURY RD SUITE K
LITTLETON NH
03561-3437
US

V. Phone/Fax

Practice location:
  • Phone: 603-444-2010
  • Fax: 603-444-2181
Mailing address:
  • Phone: 603-444-2010
  • Fax: 603-444-2181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number0444P
License Number StateNH

VIII. Authorized Official

Name: MRS. ANGELA MARIA HAWKINS
Title or Position: OWNER/PARTNER
Credential: PA-C
Phone: 603-444-2010