Provider Demographics
NPI:1467502872
Name:MILLSPAUGH, ALICE MARIE (APRN, BC, GNP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:MARIE
Last Name:MILLSPAUGH
Suffix:
Gender:F
Credentials:APRN, BC, GNP
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:MARIE
Other - Last Name:BROCKWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, BC, GNP
Mailing Address - Street 1:50 PHEASANT RD
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-2110
Mailing Address - Country:US
Mailing Address - Phone:603-924-7267
Mailing Address - Fax:603-924-7885
Practice Address - Street 1:50 PHEASANT RD
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-2110
Practice Address - Country:US
Practice Address - Phone:603-924-7267
Practice Address - Fax:603-924-7885
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA131614363LG0600X
NH032065-23-06363LG0600X
NYF340734-1363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP268861Medicare UPIN
MA225154Medicare PIN
MABR NP3108Medicare PIN