Provider Demographics
NPI:1417153545
Name:DEPARTMENT OF VETERANS AFFAIRS
Entity Type:Organization
Organization Name:DEPARTMENT OF VETERANS AFFAIRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHONY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-216-2557
Mailing Address - Street 1:2 CABOT DR
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-4228
Mailing Address - Country:US
Mailing Address - Phone:603-216-2557
Mailing Address - Fax:
Practice Address - Street 1:2 CABOT DR
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-4228
Practice Address - Country:US
Practice Address - Phone:603-216-2557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA182934282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA182934OtherNURSING LICENSE