Healthcare Provider Details

I. General information

NPI: 1710633078
Provider Name (Legal Business Name): PHILLIP JOSEPH ATHERTON DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELLIOT WAY
MANCHESTER NH
03103-3502
US

IV. Provider business mailing address

30 IRVING DR
CONCORD NH
03301-8625
US

V. Phone/Fax

Practice location:
  • Phone: 603-669-5300
  • Fax:
Mailing address:
  • Phone: 603-978-1208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number087625-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: