Healthcare Provider Details

I. General information

NPI: 1881040905
Provider Name (Legal Business Name): CONNELLY, GAGNE & PRUSSEL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2016
Last Update Date: 05/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 AMHERST ST SUITE #4
NASHUA NH
03063-1220
US

IV. Provider business mailing address

460 AMHERST ST SUITE #4
NASHUA NH
03063-1220
US

V. Phone/Fax

Practice location:
  • Phone: 603-589-9570
  • Fax: 603-589-9567
Mailing address:
  • Phone: 603-589-9570
  • Fax: 603-589-9567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number03872
License Number StateNH

VIII. Authorized Official

Name: ANN M PRUSSEL
Title or Position: CEO
Credential: RN
Phone: 603-689-8818