MEDICARE: MRS. ANNE M DELUCA APRN

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	363LA2200X	Adult Health Nurse Practitioner	036744-23-05	NH

General Provider Information

NPI Number	:	1518002112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNE M DELUCA APRN

Provider Business Mailing Address
First Line	:	11 KIMBALL DR
Second Line	:
City	:	HOOKSETT
State	:	NH
Zip	:	03106-2603
Country	:	US
Telephone Number	:	603-663-1990
Fax Number	:	603-663-1989

Provider Business Practice Location Address
First Line	:	11 KIMBALL DR
Second Line	:
City	:	HOOKSETT
State	:	NH
Zip	:	03106-2603
Country	:	US
Telephone Number	:	603-663-1990
Fax Number	:	603-663-1989

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	04/14/2015

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