1861878571 NPI number — SUSAN F MIRABELLO APRN

Table of content: SUSAN F MIRABELLO APRN (NPI 1861878571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861878571 NPI number — SUSAN F MIRABELLO APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIRABELLO
Provider First Name:
SUSAN
Provider Middle Name:
F
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:
1861878571
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
875 ELM ST APT 507
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03101-2124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-663-6478
Provider Business Mailing Address Fax Number:
603-663-8015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MCGREGOR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03102-3730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-663-6478
Provider Business Practice Location Address Fax Number:
603-663-8015
Provider Enumeration Date:
08/04/2015

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: 363L00000X , with the licence number:  056350-23 , 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)