Healthcare Provider Details

I. General information

NPI: 1790573335
Provider Name (Legal Business Name): DANIELLE R MARTINEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 03/14/2026
Certification Date: 03/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 ELM ST
MANCHESTER NH
03101-1305
US

IV. Provider business mailing address

1260 ELM ST
MANCHESTER NH
03101-1305
US

V. Phone/Fax

Practice location:
  • Phone: 603-314-1701
  • Fax:
Mailing address:
  • Phone: 603-479-1771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3641
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0009680
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: