Healthcare Provider Details

I. General information

NPI: 1942267273
Provider Name (Legal Business Name): LAURICE JACKSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WINTER ST
ROCHESTER NH
03867-3153
US

IV. Provider business mailing address

652F CENTRAL AVE
DOVER NH
03820-3414
US

V. Phone/Fax

Practice location:
  • Phone: 603-332-5500
  • Fax: 603-332-0410
Mailing address:
  • Phone: 603-749-2346
  • Fax: 603-953-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number010948-23-03
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: