Healthcare Provider Details

I. General information

NPI: 1144368770
Provider Name (Legal Business Name): PAULA MARIE PHILLIPS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULA STEADMAN RN

II. Dates (important events)

Enumeration Date: 02/03/2007
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W MAIN ST STE 400
TILTON NH
03276-5047
US

IV. Provider business mailing address

630 W MAIN ST STE 400
TILTON NH
03276-5047
US

V. Phone/Fax

Practice location:
  • Phone: 603-624-4366
  • Fax: 603-314-1653
Mailing address:
  • Phone: 603-624-4366
  • Fax: 603-314-1653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number042516-21
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number042516-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: