Healthcare Provider Details

I. General information

NPI: 1225741309
Provider Name (Legal Business Name): HOLISTIC CARE GAP SOLUTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 HANOVER ST STE 200
MANCHESTER NH
03101-2230
US

IV. Provider business mailing address

66 HANOVER ST STE 200
MANCHESTER NH
03101-2230
US

V. Phone/Fax

Practice location:
  • Phone: 617-419-6513
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALEX MUTUKU
Title or Position: MANAGER
Credential: APRN
Phone: 617-419-6513