1902870603 NPI number — DONNA L. CHRETIEN ARNP

Table of content: DONNA L. CHRETIEN ARNP (NPI 1902870603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902870603 NPI number — DONNA L. CHRETIEN ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRETIEN
Provider First Name:
DONNA
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:
1902870603
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
138 WEBSTER ST
Provider Second Line Business Mailing Address:
SENIOR HEALTH PRIMARY CARE
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03104-2512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-663-7030
Provider Business Mailing Address Fax Number:
603-663-7039

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
138 WEBSTER ST
Provider Second Line Business Practice Location Address:
SENIOR HEALTH PRIMARY CARE
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03104-2512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-663-7030
Provider Business Practice Location Address Fax Number:
603-663-7039
Provider Enumeration Date:
02/17/2006

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: 363L00000X , with the licence number:  029056-23-05 , 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: 437940 . This is a "CIGNA PIN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: P06883 . This is a "ANTHEM REFERRING PIN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: P06883 . This is a "HARVARD PILGRIM PIN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 029056 . This is a "TUFTS PIN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30340828 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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