1760426548 NPI number — LAURA L ZAKORCHEMNY ARNP

Table of content: LAURA L ZAKORCHEMNY ARNP (NPI 1760426548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760426548 NPI number — LAURA L ZAKORCHEMNY ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZAKORCHEMNY
Provider First Name:
LAURA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
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:
1760426548
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112-114 SANFORD ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLS
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04090-5533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-646-5211
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 STRAFFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LACONIA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03246-4701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-366-1070
Provider Business Practice Location Address Fax Number:
603-366-1071
Provider Enumeration Date:
06/15/2006

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: 363LP2300X , with the licence number:  061631-23 , 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: 1760426548 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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