Healthcare Provider Details

I. General information

NPI: 1790201069
Provider Name (Legal Business Name): LYDIA S HUSTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 08/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 VILLAGE DR
MEREDITH NH
03253-5739
US

IV. Provider business mailing address

80 HIGHLAND ST
LACONIA NH
03246-3235
US

V. Phone/Fax

Practice location:
  • Phone: 603-491-1599
  • Fax:
Mailing address:
  • Phone: 603-524-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number042518-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: