1750810347 NPI number — MRS. MEGAN M SOTTAK APRN

Table of content: MRS. MEGAN M SOTTAK APRN (NPI 1750810347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750810347 NPI number — MRS. MEGAN M SOTTAK APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOTTAK
Provider First Name:
MEGAN
Provider Middle Name:
M
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:
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:
1750810347
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1327
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LACONIA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03247-1327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-934-2060
Provider Business Mailing Address Fax Number:
603-527-7038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HILLSIDE FAMILY MEDICINE
Provider Second Line Business Practice Location Address:
14 MAPLE STREET
Provider Business Practice Location Address City Name:
GILFORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03249-6578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-527-7114
Provider Business Practice Location Address Fax Number:
603-527-2945
Provider Enumeration Date:
06/07/2017

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: 207Q00000X , with the licence number:  056352-23 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 056352-23 , 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: 3110623 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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