=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609263383
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLI T MOFOR APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2015
-----------------------------------------------------
Last Update Date | 01/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 80 HIGHLAND ST
-----------------------------------------------------
City | LACONIA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03246-3235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-524-3211
-----------------------------------------------------
Fax | 603-737-6713
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1327
-----------------------------------------------------
City | LACONIA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03247-1327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-524-3211
-----------------------------------------------------
Fax | 603-527-7038
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | RN1022985
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 020222150
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 071452-23
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | F34122901
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 341229
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------