Healthcare Provider Details

I. General information

NPI: 1235452491
Provider Name (Legal Business Name): DANIELLE MARIE MAHAN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE MARIE COCHRAN

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PROSPECT ST SUITE 303
NASHUA NH
03060-3922
US

IV. Provider business mailing address

PO BOX 3677
NASHUA NH
03061-3677
US

V. Phone/Fax

Practice location:
  • Phone: 603-577-3100
  • Fax: 603-577-3015
Mailing address:
  • Phone: 603-577-7900
  • Fax: 603-577-7972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number066922-23
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number066922-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: