Healthcare Provider Details

I. General information

NPI: 1063704997
Provider Name (Legal Business Name): CHRISTINA DANIELLE HURLEY MPAS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA DANILLE GODFREY

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 11/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 HEALTHCARE DR STE 1
ROCHESTER NH
03867-4499
US

IV. Provider business mailing address

6 HEALTHCARE DR STE 1
ROCHESTER NH
03867-4499
US

V. Phone/Fax

Practice location:
  • Phone: 603-994-6400
  • Fax: 603-994-6443
Mailing address:
  • Phone: 603-994-6400
  • Fax: 603-994-6443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0820
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: