1669722013 NPI number — MRS. LEEANNE S MATHER APRN

Table of content: MRS. LEEANNE S MATHER APRN (NPI 1669722013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669722013 NPI number — MRS. LEEANNE S MATHER APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATHER
Provider First Name:
LEEANNE
Provider Middle Name:
S
Provider Name Prefix Text:
MRS.
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:
SCHOENFELD
Provider Other First Name:
LEEANNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669722013
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 HOLLAND WAY FL 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EXETER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03833-2997
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-772-5528
Provider Business Mailing Address Fax Number:
603-777-1296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 ALUMNI DR
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
EXETER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03833-2119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-772-5528
Provider Business Practice Location Address Fax Number:
603-777-1296
Provider Enumeration Date:
09/13/2012

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:  064302-23 , 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: 3078641 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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