1265968515 NPI number — MELISSA KANTER APRN

Table of content: MELISSA KANTER APRN (NPI 1265968515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265968515 NPI number — MELISSA KANTER APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KANTER
Provider First Name:
MELISSA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265968515
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3073 WHITE MOUNTAIN HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH CONWAY
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03860-7101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-356-5472
Provider Business Mailing Address Fax Number:
603-356-9647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3073 WHITE MOUNTAIN HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH CONWAY
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-356-5472
Provider Business Practice Location Address Fax Number:
603-356-9647
Provider Enumeration Date:
05/05/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  0000217520 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 23244 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 078722-23 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3114205 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".