1902637754 NPI number — CHERYL DOUCETTE ANP BC PMHCNS BC LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902637754 NPI number — CHERYL DOUCETTE ANP BC PMHCNS BC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHERYL DOUCETTE ANP BC PMHCNS BC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1902637754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH WOODSTOCK
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03262-0005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-728-8872
Provider Business Mailing Address Fax Number:
603-745-7089

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 MOUNTAIN PARK DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODSTOCK
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03262-0005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-728-8872
Provider Business Practice Location Address Fax Number:
603-745-7089
Provider Enumeration Date:
08/13/2024

Additional Information

Authorized Official

Authorized Official Last Name:
DOUCETTE
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER, MANAGER
Authorized Official Telephone Number:
603-728-8872

Provider Taxonomy Codes

  • Taxonomy code: 364SP0809X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1316969611 . This is a "PROVIDER NPI" identifier . This identifiers is of the category "OTHER".




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