1720231616 NPI number — ROBERTA STANHOPE ARNP,PMH, CNS, BC

Table of content: ROBERTA STANHOPE ARNP,PMH, CNS, BC (NPI 1720231616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720231616 NPI number — ROBERTA STANHOPE ARNP,PMH, CNS, BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STANHOPE
Provider First Name:
ROBERTA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP,PMH, CNS, BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STANHOPE
Provider Other First Name:
ROBERTA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP,PMH,CNS,BC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1720231616
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13 JENKINS CT STE 220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03824-2324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-651-0293
Provider Business Mailing Address Fax Number:
603-815-4944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13 JENKINS CT
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03824-2340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-651-0293
Provider Business Practice Location Address Fax Number:
603-815-4944
Provider Enumeration Date:
10/23/2008

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: 163WP0809X , with the licence number:  054414-21 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0809X , with the licence number: 054414-23 , 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: 12012954 . This is a "CAQH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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