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General NPI Number Information
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NPI Number | 1184418311
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Entity Type | Individual
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Provider Name | TRACEY DAMON APRN
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Gender | Female
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Dates
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Enumeration Date | 04/04/2025
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 333 BORTHWICK AVE STE 100
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City | PORTSMOUTH
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State | NH
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Zip | 03801-4198
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Country | US
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Telephone | 603-436-5110
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Fax |
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Provider Business Mailing Address
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Address Line | 8 WHITTAKER DR
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City | STRATHAM
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State | NH
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Zip | 03885-2278
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Country | US
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Telephone | 603-498-5418
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0701-46-23
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License Number State | NH
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