Healthcare Provider Details

I. General information

NPI: 1760756167
Provider Name (Legal Business Name): MARY BETH KRISS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY BETH WEATHERFORD

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 COLISEUM AVE
NASHUA NH
03063-3292
US

IV. Provider business mailing address

26 KENDRICK LN
MILFORD NH
03055-3574
US

V. Phone/Fax

Practice location:
  • Phone: 603-882-9800
  • Fax: 603-882-0556
Mailing address:
  • Phone: 603-554-8085
  • Fax: 603-882-0556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number112901
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: