Healthcare Provider Details

I. General information

NPI: 1841392024
Provider Name (Legal Business Name): IVY JOYCE GABAI ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 QUEEN CITY AVE
MANCHESTER NH
03103-7122
US

IV. Provider business mailing address

69 MACK HILL RD
AMHERST NH
03031-3225
US

V. Phone/Fax

Practice location:
  • Phone: 603-622-3020
  • Fax: 603-621-4295
Mailing address:
  • Phone: 603-305-6648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number139600
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number038134-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: