Healthcare Provider Details

I. General information

NPI: 1811236664
Provider Name (Legal Business Name): AMOSKEAG PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 ELM ST SUITE 302
MANCHESTER NH
03101-1217
US

IV. Provider business mailing address

300 SHERBURNE RD
PELHAM NH
03076-3373
US

V. Phone/Fax

Practice location:
  • Phone: 603-623-7924
  • Fax: 603-623-7924
Mailing address:
  • Phone: 603-557-0458
  • Fax: 603-623-7924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number052850-23
License Number StateNH

VIII. Authorized Official

Name: JENNIFER CHRISEMER
Title or Position: NURE PRACTICIONER
Credential: ARNP, FNP-BC
Phone: 603-623-3343