Healthcare Provider Details

I. General information

NPI: 1992855878
Provider Name (Legal Business Name): HEATHER LAYFIELD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 BORTHWICK AVE
PORTSMOUTH NH
03801-7128
US

IV. Provider business mailing address

380 LAFAYETTE RD
HAMPTON NH
03842-2222
US

V. Phone/Fax

Practice location:
  • Phone: 603-433-4012
  • Fax: 603-926-2853
Mailing address:
  • Phone: 603-926-0088
  • Fax: 603-926-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103706
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0747
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: