Healthcare Provider Details

I. General information

NPI: 1639762594
Provider Name (Legal Business Name): REBECCA THOMPSON HOULIHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PORTSMOUTH AVE
STRATHAM NH
03885-2520
US

IV. Provider business mailing address

111 NEW HAMPSHIRE AVE STE 2
PORTSMOUTH NH
03801-2864
US

V. Phone/Fax

Practice location:
  • Phone: 603-772-3600
  • Fax:
Mailing address:
  • Phone: 603-319-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP211179
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number084255-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: