Provider Demographics
NPI:1508080391
Name:ELLIOT HOSPITAL
Entity Type:Organization
Organization Name:ELLIOT HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADULT NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP,MSN
Authorized Official - Phone:603-663-8400
Mailing Address - Street 1:275 MAMMOTH RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109-4133
Mailing Address - Country:US
Mailing Address - Phone:603-663-8400
Mailing Address - Fax:603-663-8497
Practice Address - Street 1:275 MAMMOTH RD
Practice Address - Street 2:SUITE 3
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109-4133
Practice Address - Country:US
Practice Address - Phone:603-663-8400
Practice Address - Fax:603-663-8497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH039363-23-05282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital