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General NPI Number Information
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NPI Number | 1134544778
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Entity Type | Individual
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Provider Name | MICHELLE VICENTE
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Gender | Female
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Dates
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Enumeration Date | 02/19/2014
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 286 WINDING POND RD
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City | LONDONDERRY
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State | NH
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Zip | 03053-3379
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Country | US
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Telephone | 603-437-3344
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Fax |
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Provider Business Mailing Address
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Address Line | 286 WINDING POND RD
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City | LONDONDERRY
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State | NH
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Zip | 03053-3379
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | 192048
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License Number State | MA
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