Healthcare Provider Details

I. General information

NPI: 1326801606
Provider Name (Legal Business Name): MATTHEW EBBIGHAUSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 AMHERST ST STE 101
NASHUA NH
03063-1276
US

IV. Provider business mailing address

436 AMHERST ST STE 201
NASHUA NH
03063-1276
US

V. Phone/Fax

Practice location:
  • Phone: 603-577-3003
  • Fax: 603-577-3331
Mailing address:
  • Phone: 603-577-3003
  • Fax: 603-577-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number092967-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: