Provider Demographics
NPI:1568076818
Name:FANNON, DANNA SEAHOLM (FNP)
Entity Type:Individual
Prefix:
First Name:DANNA
Middle Name:SEAHOLM
Last Name:FANNON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 OLDFIELDS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03908-1757
Mailing Address - Country:US
Mailing Address - Phone:774-571-8413
Mailing Address - Fax:
Practice Address - Street 1:599 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5409
Practice Address - Country:US
Practice Address - Phone:603-942-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHF02210912363LF0000X
NH073860-23363LF0000X
NH073860-21163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse