Healthcare Provider Details

I. General information

NPI: 1073905592
Provider Name (Legal Business Name): LYNETTE VIGNOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 BRIDGE ST
PELHAM NH
03076-3400
US

IV. Provider business mailing address

43 BRIDGE ST
PELHAM NH
03076-3400
US

V. Phone/Fax

Practice location:
  • Phone: 603-635-2151
  • Fax:
Mailing address:
  • Phone: 603-635-2151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number1564
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: