Healthcare Provider Details

I. General information

NPI: 1205170107
Provider Name (Legal Business Name): JESSICA L. LAMONTAGNE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3073 WHITE MOUNTAIN HWY
NORTH CONWAY NH
03860-7101
US

IV. Provider business mailing address

3073 WHITE MOUNTAIN HWY
NORTH CONWAY NH
03860-7101
US

V. Phone/Fax

Practice location:
  • Phone: 603-356-5472
  • Fax:
Mailing address:
  • Phone: 603-356-5472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number042442-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: