Provider Demographics
NPI:1497892087
Name:HEALEY, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HEALEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 E WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03244-4008
Mailing Address - Country:US
Mailing Address - Phone:603-478-1760
Mailing Address - Fax:
Practice Address - Street 1:22 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3924
Practice Address - Country:US
Practice Address - Phone:603-883-1626
Practice Address - Fax:603-881-9914
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH056655-23367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30462038Medicaid