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General NPI Number Information
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NPI Number | 1760789143
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Entity Type | Individual
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Provider Name | AMY REBECCA BACON-FORD
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Gender | Female
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Dates
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Enumeration Date | 02/21/2011
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Last Update Date | 08/04/2023
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Provider Practice Location Address
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Address Line | 1 ELLIOT WAY
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City | MANCHESTER
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State | NH
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Zip | 03103-3502
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Country | US
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Telephone | 603-663-2766
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Fax |
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Provider Business Mailing Address
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Address Line | 1 ELLIOT WAY
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City | MANCHESTER
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State | NH
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Zip | 03103-3599
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Country | US
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Telephone | 603-663-3388
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 072006-23
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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