Healthcare Provider Details

I. General information

NPI: 1407611155
Provider Name (Legal Business Name): LEAH ROSE TULLY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 COUNTY RD
NEW LONDON NH
03257-7700
US

IV. Provider business mailing address

12 MOUNTAIN OVERLOOK
WILMOT NH
03287-4731
US

V. Phone/Fax

Practice location:
  • Phone: 603-526-2911
  • Fax:
Mailing address:
  • Phone: 774-402-0690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number079368-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number079368-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: