Provider Demographics
NPI:1346558491
Name:HAVERTY-BUSSIERE, DOROTHY (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:
Last Name:HAVERTY-BUSSIERE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MRS
Other - First Name:DOROTHY
Other - Middle Name:HAVERTY
Other - Last Name:BUSSIERE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:21 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03076-3722
Mailing Address - Country:US
Mailing Address - Phone:603-635-8402
Mailing Address - Fax:
Practice Address - Street 1:411 MERRIMACK ST
Practice Address - Street 2:104
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5821
Practice Address - Country:US
Practice Address - Phone:978-685-5627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN217422363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health