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General NPI Number Information
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NPI Number | 1821226986
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Entity Type | Organization
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Legal Business Name | HEALTHY LIVING FAMILY PRACTICE PA
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Dates
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Enumeration Date | 06/29/2009
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Last Update Date | 06/29/2009
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Provider Practice Location Address
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Address Line | 74 MAIN ST
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City | RAYMOND
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State | NH
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Zip | 03077
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Country | US
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Telephone | 603-895-1658
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Fax | 603-895-9394
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Provider Business Mailing Address
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Address Line | PO BOX 1139
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City | RAYMOND
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State | NH
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Zip | 03077-1139
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Country | US
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Telephone | 603-895-1658
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Fax | 603-895-9394
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Authorized Official
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Title or Position | OFFICE MANAGER/VP
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Name | JAN J RAJCHEL
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Credential |
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Telephone | 603-895-1658
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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 | 026533-23
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License Number State | NH
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