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General NPI Number Information
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NPI Number | 1942750351
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Entity Type | Organization
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Legal Business Name | DOORYARDNP, LLC
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Dates
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Enumeration Date | 10/10/2016
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 21 CRAWFORD ST
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City | LITTLETON
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State | NH
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Zip | 03561-5502
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Country | US
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Telephone | 603-236-9230
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Fax |
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Provider Business Mailing Address
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Address Line | 21 CRAWFORD ST PO BOX 905
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City | LITTLETON
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State | NH
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Zip | 03561-5502
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Country | US
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Telephone | 603-236-9230
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MICHAEL SCANLON
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Credential | APRN, NP-C
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Telephone | 603-236-9230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 054066-23
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License Number State | NH
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