=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609166123
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER M TUDEN PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2011
-----------------------------------------------------
Last Update Date | 07/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2300 SOUTHWOOD DR
-----------------------------------------------------
City | NASHUA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03063-1818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-577-4440
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2300 SOUTHWOOD DR
-----------------------------------------------------
City | NASHUA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03063-1818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-577-4400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 0826
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------