Healthcare Provider Details

I. General information

NPI: 1366795767
Provider Name (Legal Business Name): ALICIA M. KLECZKOWSKI A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 BUTTRICK RD
LONDONDERRY NH
03053-3381
US

IV. Provider business mailing address

40 BUTTRICK RD
LONDONDERRY NH
03053-3381
US

V. Phone/Fax

Practice location:
  • Phone: 603-552-1400
  • Fax:
Mailing address:
  • Phone: 603-552-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN277087
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number058783-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: