Healthcare Provider Details

I. General information

NPI: 1083804991
Provider Name (Legal Business Name): ELLEN DENNEHY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEN STEWART PA

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S MAIN ST
WOLFEBORO NH
03894-4455
US

IV. Provider business mailing address

240 S MAIN ST
WOLFEBORO NH
03894-4455
US

V. Phone/Fax

Practice location:
  • Phone: 603-569-7574
  • Fax: 603-569-7582
Mailing address:
  • Phone: 603-569-7574
  • Fax: 603-569-7582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2312
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1250
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: