Healthcare Provider Details

I. General information

NPI: 1568983328
Provider Name (Legal Business Name): LAUREN MARGARET STACY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 07/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 OLD STREET RD
PETERBOROUGH NH
03458-1200
US

IV. Provider business mailing address

45 OLD HANCOCK RD
HANCOCK NH
03449-6015
US

V. Phone/Fax

Practice location:
  • Phone: 603-924-7191
  • Fax:
Mailing address:
  • Phone: 603-525-4902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number042341-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number042341-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: