MEDICARE: DR. GLORIA GIAVENO STRAUGHN ARNP, CS, BC, PHD

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	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	020052-21	NH
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	020052-23-08	NH
3	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist		NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700072857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLORIA GIAVENO STRAUGHN ARNP, CS, BC, PHD

Provider Business Mailing Address
First Line	:	497 HOOKSETT RD
Second Line	:	SUITE 325
City	:	MANCHESTER
State	:	NH
Zip	:	03104-2632
Country	:	US
Telephone Number	:	603-224-0101
Fax Number	:	603-668-2191

Provider Business Practice Location Address
First Line	:	722 ROUTE 3A
Second Line	:	SUITE 15
City	:	BOW
State	:	NH
Zip	:	03304-4010
Country	:	US
Telephone Number	:	603-224-0101
Fax Number	:	603-668-2191

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

Provider Enumeration Date	:	09/22/2007
Last Update Date	:	09/22/2007

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