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General NPI Number Information
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NPI Number | 1114536877
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE HEALTH & WELLNESS CLINIC
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Dates
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Enumeration Date | 07/29/2020
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 1283 MAIN ST UNIT 6C
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City | DUBLIN
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State | NH
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Zip | 03444-8242
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Country | US
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Telephone | 603-831-1191
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Fax | 833-924-0345
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Provider Business Mailing Address
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Address Line | 48 NORTH RD
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City | HANCOCK
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State | NH
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Zip | 03449-5508
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Country | US
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Telephone | 603-831-1911
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Fax | 833-924-0345
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MARYLOU CASSIDY
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Credential | APRN
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Telephone | 603-831-1191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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