Healthcare Provider Details

I. General information

NPI: 1336318237
Provider Name (Legal Business Name): BARBARA A LAVERACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 HOSPITAL RD SPEARE MEMORIAL HOSPITAL
PLYMOUTH NH
03264-1126
US

IV. Provider business mailing address

16 HOSPITAL RD SPEARE MEMORIAL HOSPITAL
PLYMOUTH NH
03264-1126
US

V. Phone/Fax

Practice location:
  • Phone: 603-536-1120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number01068
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: