Healthcare Provider Details

I. General information

NPI: 1316469547
Provider Name (Legal Business Name): AMARYLLIS ELAINE HAGER CNM, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 07/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 PENNACOOK ST
MANCHESTER NH
03104-3554
US

IV. Provider business mailing address

71 HOLDEN RD
STERLING MA
01564-2467
US

V. Phone/Fax

Practice location:
  • Phone: 603-669-7321
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number104405265
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCNM03967
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: