Healthcare Provider Details

I. General information

NPI: 1861970972
Provider Name (Legal Business Name): NORRINE MCNELLEY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 02/02/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 MAIN ST STE 102
SALEM NH
03079-3170
US

IV. Provider business mailing address

202 MAIN ST STE 102
SALEM NH
03079-3170
US

V. Phone/Fax

Practice location:
  • Phone: 603-892-9922
  • Fax: 603-458-1329
Mailing address:
  • Phone: 603-892-9922
  • Fax: 603-458-1329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2291388
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: