Healthcare Provider Details

I. General information

NPI: 1043818099
Provider Name (Legal Business Name): JESSICA GLUEK PLUTA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 INDIAN ROCK RD
WINDHAM NH
03087-2008
US

IV. Provider business mailing address

PO BOX 986523
BOSTON MA
02298-6523
US

V. Phone/Fax

Practice location:
  • Phone: 603-890-6330
  • Fax:
Mailing address:
  • Phone: 603-410-6700
  • Fax: 603-319-8308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number073817-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: