Healthcare Provider Details

I. General information

NPI: 1033502588
Provider Name (Legal Business Name): KAYLEIGH REBECCA MAAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLEIGH REBECCA BOOTHBY

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 NORTHWEST BLVD
NASHUA NH
03063-4068
US

IV. Provider business mailing address

29 NORTHWEST BLVD
NASHUA NH
03063-4068
US

V. Phone/Fax

Practice location:
  • Phone: 603-577-2273
  • Fax: 603-577-5191
Mailing address:
  • Phone: 603-577-2273
  • Fax: 603-577-5191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1074
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA5261
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: