Provider Demographics
NPI:1104370154
Name:SENNEVILLE, ERIC ALLEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:ALLEN
Last Name:SENNEVILLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CHAMBERS DR STE 2200
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-1981
Mailing Address - Country:US
Mailing Address - Phone:603-641-5386
Mailing Address - Fax:
Practice Address - Street 1:20 CHAMBERS DR STE 2200
Practice Address - Street 2:
Practice Address - City:HOOKSETT
Practice Address - State:NH
Practice Address - Zip Code:03106-1981
Practice Address - Country:US
Practice Address - Phone:603-641-5386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1194363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical