Healthcare Provider Details

I. General information

NPI: 1598294167
Provider Name (Legal Business Name): AMY MARIE MCCORMACK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BOULDER POINT DR STE 1
PLYMOUTH NH
03264-3170
US

IV. Provider business mailing address

213 FAIRGROUNDS RD
PLYMOUTH NH
03264-3228
US

V. Phone/Fax

Practice location:
  • Phone: 603-536-4000
  • Fax: 603-536-4001
Mailing address:
  • Phone: 603-953-3778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number062717-23
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number062717-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: