Healthcare Provider Details

I. General information

NPI: 1578956538
Provider Name (Legal Business Name): LAUREN M ZANETTI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2015
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 BORTHWICK AVE STE C
PORTSMOUTH NH
03801-7156
US

IV. Provider business mailing address

PO BOX 911
BRATTLEBORO VT
05302-0911
US

V. Phone/Fax

Practice location:
  • Phone: 603-828-0100
  • Fax: 603-828-0111
Mailing address:
  • Phone: 207-303-3200
  • Fax: 207-250-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1929
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1479
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: