=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992855878
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER LAYFIELD PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2007
-----------------------------------------------------
Last Update Date | 04/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 BORTHWICK AVE
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03801-7128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-433-4012
-----------------------------------------------------
Fax | 603-926-2853
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 380 LAFAYETTE RD
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03842-2222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-926-0088
-----------------------------------------------------
Fax | 603-926-2853
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 103706
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 0747
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------