Healthcare Provider Details

I. General information

NPI: 1609437706
Provider Name (Legal Business Name): HEIDI NICHOLE BUXTON MSN, FNP-C,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI BARINGER

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELLIOT WAY
MANCHESTER NH
03103-3502
US

IV. Provider business mailing address

1 ELLIOT WAY
MANCHESTER NH
03103-3502
US

V. Phone/Fax

Practice location:
  • Phone: 603-663-2710
  • Fax: 603-663-3439
Mailing address:
  • Phone: 603-663-2710
  • Fax: 603-663-3439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number053391-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: