Provider Demographics
NPI:1457827305
Name:MANSFIELD MEDICAL CONSULTING LLC
Entity Type:Organization
Organization Name:MANSFIELD MEDICAL CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:570-762-1923
Mailing Address - Street 1:PO BOX 1007
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-1007
Mailing Address - Country:US
Mailing Address - Phone:603-662-0166
Mailing Address - Fax:888-295-5032
Practice Address - Street 1:45 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-6031
Practice Address - Country:US
Practice Address - Phone:603-662-0166
Practice Address - Fax:888-295-5032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty