Healthcare Provider Details

I. General information

NPI: 1568801165
Provider Name (Legal Business Name): NEUROPATHY COMFORT CENTER OF NEW ENGLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 NASHUA RD SUITE E1
LONDONDERRY NH
03053-3446
US

IV. Provider business mailing address

25 NASHUA RD SUITE E1
LONDONDERRY NH
03053-3446
US

V. Phone/Fax

Practice location:
  • Phone: 603-552-3309
  • Fax: 603-965-4177
Mailing address:
  • Phone: 603-552-3309
  • Fax: 603-965-4177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number05965623
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number059656-23
License Number StateNH

VIII. Authorized Official

Name: MS. VICTORIA GORVEATT
Title or Position: NURSE PRACTITIONER / DIRECTOR
Credential: APRN
Phone: 603-552-3309