1568636165 NPI number — MS. COLETTE NICOLE TILTON ARNP

Table of content: MS. COLETTE NICOLE TILTON ARNP (NPI 1568636165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568636165 NPI number — MS. COLETTE NICOLE TILTON ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TILTON
Provider First Name:
COLETTE
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TILTON
Provider Other First Name:
COLETTE
Provider Other Middle Name:
DOUGLAS
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1568636165
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 PROSPECT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHUA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03060-3924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-883-1626
Provider Business Mailing Address Fax Number:
603-881-9914

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 PROSPECT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03060-3924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-883-1626
Provider Business Practice Location Address Fax Number:
603-881-9914
Provider Enumeration Date:
04/15/2008

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: 363LF0000X , with the licence number:  013838-23 , 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: 30342439 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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