MEDICARE: BRITTANIE LISTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist

General Provider Information

NPI Number	:	1316509128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANIE LISTER

Provider Business Mailing Address
First Line	:	17 HILL ST
Second Line	:
City	:	HUDSON
State	:	NH
Zip	:	03051-3631
Country	:	US
Telephone Number	:	978-914-2869
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 HILL ST
Second Line	:
City	:	HUDSON
State	:	NH
Zip	:	03051-3631
Country	:	US
Telephone Number	:	978-914-2869
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2019
Last Update Date	:	07/01/2019

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