1154905180 NPI number — MICHELLE C COONEY

Table of content: MICHELLE C COONEY (NPI 1154905180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154905180 NPI number — MICHELLE C COONEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COONEY
Provider First Name:
MICHELLE
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
INDELICATO
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
C
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:
1154905180
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3677
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:
03061-3677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-577-7900
Provider Business Mailing Address Fax Number:
603-577-7972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 SPIT BROOK RD
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:
03062-2711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-888-5573
Provider Business Practice Location Address Fax Number:
603-891-6910
Provider Enumeration Date:
05/06/2021

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:  085144-23 , 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)