=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235885419
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COLBY HERRICK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2022
-----------------------------------------------------
Last Update Date | 08/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 WINNEPOCKET RD
-----------------------------------------------------
City | WEBSTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03303-7510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-340-1412
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 70 WINNEPOCKET RD
-----------------------------------------------------
City | WEBSTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03303-7510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-340-1412
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | TBD
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 075718-21
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------