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General NPI Number Information
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NPI Number | 1144732074
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Entity Type | Organization
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Legal Business Name | ALTUM PSYCHIATRIC SERVICES, PLLC
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Dates
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Enumeration Date | 11/01/2017
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Last Update Date | 11/25/2017
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Provider Practice Location Address
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Address Line | 1 BRIDGE ST STE 210
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City | PLYMOUTH
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State | NH
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Zip | 03264-1623
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Country | US
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Telephone | 352-226-3803
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Fax |
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Provider Business Mailing Address
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Address Line | 1 BRIDGE ST STE 210
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City | PLYMOUTH
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State | NH
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Zip | 03264-1623
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Country | US
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Telephone | 352-226-3803
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CYMANDE BAXTER-ROGERS
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Credential | APRN
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Telephone | 352-226-3803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 07475223
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 07475223
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License Number State | NH
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