=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306645916
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGHAN QUELCH APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2025
-----------------------------------------------------
Last Update Date | 03/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 835 HANOVER ST STE 305
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03104-5401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-784-9012
-----------------------------------------------------
Fax | 603-784-9012
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 274 KENBERMA ST
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03103-6007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-989-3594
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 077865-23
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------