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General NPI Number Information
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NPI Number | 1861002701
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Entity Type | Individual
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Provider Name | KATHLEEN P FANTOZZI FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/05/2020
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 1590 UNION ST
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City | MANCHESTER
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State | NH
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Zip | 03104-1768
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Country | US
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Telephone | 603-860-8905
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Fax |
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Provider Business Mailing Address
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Address Line | 1590 UNION ST
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City | MANCHESTER
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State | NH
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Zip | 03104-1768
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Country | US
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Telephone | 603-860-8905
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2020015527
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2020015527
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License Number State | NH
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