Provider Demographics
NPI:1285683938
Name:MCGOWAN LEE, MARTHA (ARNP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:MCGOWAN LEE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ALUMNI DR
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2118
Mailing Address - Country:US
Mailing Address - Phone:603-580-6635
Mailing Address - Fax:
Practice Address - Street 1:879 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-1258
Practice Address - Country:US
Practice Address - Phone:603-929-1195
Practice Address - Fax:603-929-1196
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0445262305363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30342744Medicaid
Q07707Medicare UPIN
NHNP4419Medicare ID - Type Unspecified