1366473944 NPI number — DONNA WHITE DEVITTE MPT

Table of content: (NPI 1619586047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366473944 NPI number — DONNA WHITE DEVITTE MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEVITTE
Provider First Name:
DONNA
Provider Middle Name:
WHITE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHITE
Provider Other First Name:
DONNA
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366473944
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
61 HIGHLAND DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENNIKER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-491-1998
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
171 PLEASANT STREET
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-228-7500
Provider Business Practice Location Address Fax Number:
603-228-3503
Provider Enumeration Date:
07/05/2006

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: 225100000X , with the licence number:  2726 , 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: 30393244 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1822292 . This is a "CAQH PROVIDER ID" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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