Healthcare Provider Details

I. General information

NPI: 1740892157
Provider Name (Legal Business Name): MRS. KATHY RAICHE-STEPHENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 MARKET ST
MANCHESTER NH
03101-1933
US

IV. Provider business mailing address

30 MECHANIC ST
MANCHESTER NH
03101-1923
US

V. Phone/Fax

Practice location:
  • Phone: 603-623-3558
  • Fax:
Mailing address:
  • Phone: 603-232-8666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: