Healthcare Provider Details

I. General information

NPI: 1720874662
Provider Name (Legal Business Name): EMILY ELIZABETH RADWICH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 KINSLEY ST
NASHUA NH
03060-3730
US

IV. Provider business mailing address

132 KINSLEY ST
NASHUA NH
03060-3730
US

V. Phone/Fax

Practice location:
  • Phone: 603-438-6129
  • Fax:
Mailing address:
  • Phone: 603-438-6129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number074529-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number074529-21
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2310392
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: