Healthcare Provider Details

I. General information

NPI: 1265499834
Provider Name (Legal Business Name): JOANNE REDDING ANCTIL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 SMYTH RD
MANCHESTER NH
03104-7004
US

IV. Provider business mailing address

218 HILLHAVEN RD
MANCHESTER NH
03104-2811
US

V. Phone/Fax

Practice location:
  • Phone: 603-624-4366
  • Fax: 603-626-6559
Mailing address:
  • Phone: 603-624-4366
  • Fax: 603-626-6559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0250592306
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: