=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891505418
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COLLEEN MARGUERITE PACKARD MS, MPH, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2025
-----------------------------------------------------
Last Update Date | 07/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 329 OLD WEST HOPKINTON RD
-----------------------------------------------------
City | HENNIKER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03242-4136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-678-9708
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 128 ROUTE 27
-----------------------------------------------------
City | RAYMOND
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03077-1230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-895-3351
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 111588-23
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 111588-21
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------