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General NPI Number Information
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NPI Number | 1457827305
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Entity Type | Organization
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Legal Business Name | MANSFIELD MEDICAL CONSULTING LLC
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Dates
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Enumeration Date | 10/18/2018
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Last Update Date | 10/18/2018
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Provider Practice Location Address
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Address Line | 45 WASHINGTON ST
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City | CONWAY
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State | NH
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Zip | 03818-6031
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Country | US
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Telephone | 603-662-0166
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Fax | 888-295-5032
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Provider Business Mailing Address
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Address Line | PO BOX 1007
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City | CONWAY
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State | NH
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Zip | 03818-1007
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Country | US
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Telephone | 603-662-0166
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Fax | 888-295-5032
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Authorized Official
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Title or Position | MANAGER
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Name | JUSTINE FIERMAN
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Credential | NP
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Telephone | 570-762-1923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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