Provider Demographics
NPI:1568591147
Name:DANG, ELLEN JOAN (APRN)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:JOAN
Last Name:DANG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 TSIENNETO RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-1584
Mailing Address - Country:US
Mailing Address - Phone:603-216-0400
Mailing Address - Fax:603-216-3800
Practice Address - Street 1:6 TSIENNETO ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038
Practice Address - Country:US
Practice Address - Phone:603-216-0400
Practice Address - Fax:603-216-3800
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH034884-23-03363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH500029002OtherRAILROAD MEDICARE
NH3083190Medicaid
NH500029002OtherRAILROAD MEDICARE