Healthcare Provider Details

I. General information

NPI: 1972559607
Provider Name (Legal Business Name): ANNE M CHOUINARD PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: ANNE MACNICHOL

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ELLIOT WAY SUITE 102
MANCHESTER NH
03103-3551
US

IV. Provider business mailing address

6 TSIENNETO RD STE 300
DERRY NH
03038-1584
US

V. Phone/Fax

Practice location:
  • Phone: 603-626-5900
  • Fax: 603-625-2180
Mailing address:
  • Phone: 603-216-0400
  • Fax: 603-216-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0243
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: