Provider Demographics
NPI:1598153777
Name:DYSON, JANINE NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:NICOLE
Last Name:DYSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JANINE
Other - Middle Name:NICOLE
Other - Last Name:SARVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 COMMERCIAL ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5096
Mailing Address - Country:US
Mailing Address - Phone:603-228-1763
Mailing Address - Fax:603-227-7539
Practice Address - Street 1:60 COMMERCIAL ST.
Practice Address - Street 2:SUITE 404
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-228-1763
Practice Address - Fax:603-227-7539
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003445363A00000X
MI5601008618363A00000X
PAMA057001363A00000X
NH1616363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant