Healthcare Provider Details

I. General information

NPI: 1518373752
Provider Name (Legal Business Name): ELIZABETH T CORRIDAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 05/29/2021
Certification Date: 05/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HITCHCOCK WAY
MANCHESTER NH
03104-4125
US

IV. Provider business mailing address

100 HITCHCOCK WAY
MANCHESTER NH
03104-4125
US

V. Phone/Fax

Practice location:
  • Phone: 603-695-2840
  • Fax:
Mailing address:
  • Phone: 603-695-2840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number084648-23
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2276831
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: