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General NPI Number Information
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NPI Number | 1588872576
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Entity Type | Individual
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Provider Name | HEATHER R GOURDIN ARNP
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Gender | Female
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 11/24/2015
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Provider Practice Location Address
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Address Line | 80 HIGHLAND STREET
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City | LACONIA
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State | NH
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Zip | 03246-3235
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Country | US
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Telephone | 603-524-5151
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Fax | 603-527-7184
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Provider Business Mailing Address
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Address Line | PO BOX 1327
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City | LACONIA
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State | NH
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Zip | 03247-1327
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Country | US
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Telephone | 603-524-3211
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Fax | 603-527-7038
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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 | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | 036635-23
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 364SN0000X
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Taxonomy Name | Neonatal Clinical Nurse Specialist
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License Number | AP4716
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License Number State | AZ
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