Healthcare Provider Details

I. General information

NPI: 1912005406
Provider Name (Legal Business Name): ELIZABETH BOUTIN MCGRATH APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
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: 603-569-7000
  • Fax: 603-569-7564
Mailing address:
  • Phone: 603-569-7000
  • Fax: 603-569-5756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number020476-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1010012591
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: