Healthcare Provider Details

I. General information

NPI: 1093992000
Provider Name (Legal Business Name): CHRISTINE ANN DUBE NPC ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 NEWPORT RD STE A
NEW LONDON NH
03257-5466
US

IV. Provider business mailing address

255 NEWPORT RD STE A
NEW LONDON NH
03257-5466
US

V. Phone/Fax

Practice location:
  • Phone: 603-526-1716
  • Fax: 603-526-1714
Mailing address:
  • Phone: 603-526-1716
  • Fax: 603-527-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number04379423
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF0807341
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: