1609335645 NPI number — HEATHER UNDERHILL WARD HURLEY

Table of content: HEATHER UNDERHILL WARD HURLEY (NPI 1609335645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609335645 NPI number — HEATHER UNDERHILL WARD HURLEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARD HURLEY
Provider First Name:
HEATHER
Provider Middle Name:
UNDERHILL
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:
WARD
Provider Other First Name:
HEATHER
Provider Other Middle Name:
UNDERHILL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1609335645
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 HANOVER ST STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03766-1312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
52 W PLEASANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAREMONT
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03743-3055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-542-2578
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2019

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3077550 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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