Provider Demographics
NPI:1124576640
Name:MAGLIOCCHETTI, KIMBERLY LANE (NP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:LANE
Last Name:MAGLIOCCHETTI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3677
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03061-3677
Mailing Address - Country:US
Mailing Address - Phone:603-891-6952
Mailing Address - Fax:603-891-6970
Practice Address - Street 1:112 SPIT BROOK RD
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-2711
Practice Address - Country:US
Practice Address - Phone:603-891-6952
Practice Address - Fax:603-891-6970
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH074296-23363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner