Healthcare Provider Details

I. General information

NPI: 1750386389
Provider Name (Legal Business Name): MARY LYNN FAHEY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PORTSMOUTH AVE
STRATHAM NH
03885-2585
US

IV. Provider business mailing address

100 SHATTUCK WAY STE 100
NEWINGTON NH
03801-8007
US

V. Phone/Fax

Practice location:
  • Phone: 603-943-3600
  • Fax: 603-630-1009
Mailing address:
  • Phone: 603-431-6677
  • Fax: 603-610-2232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN203678
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number027443-23-03
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number027443-23-03
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: