=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194685370
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOOSILAUKE VISIONS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2025
-----------------------------------------------------
Last Update Date | 11/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23 S MAIN ST STE 2A
-----------------------------------------------------
City | HANOVER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03755-2075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-353-9102
-----------------------------------------------------
Fax | 603-353-9412
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23 S MAIN ST STE 2A
-----------------------------------------------------
City | HANOVER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03755-2075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-353-9102
-----------------------------------------------------
Fax | 603-353-9412
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING SPECIALIST
-----------------------------------------------------
Name | ASHLEY BRICKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 603-353-9102
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------