Healthcare Provider Details

I. General information

NPI: 1871236026
Provider Name (Legal Business Name): MARY BETH LACOY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 WORKS WAY
SOMERSWORTH NH
03878-1639
US

IV. Provider business mailing address

7 WORKS WAY
SOMERSWORTH NH
03878-1639
US

V. Phone/Fax

Practice location:
  • Phone: 603-692-4018
  • Fax: 833-944-2270
Mailing address:
  • Phone: 603-692-4018
  • Fax: 833-944-2270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number087843
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number087843-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: