Provider Demographics
NPI:1629390935
Name:ADVANCED NURSE PRACTITIONER SERVICES, LLC
Entity Type:Organization
Organization Name:ADVANCED NURSE PRACTITIONER SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:603-942-5694
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:W NOTTINGHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03291-0194
Mailing Address - Country:US
Mailing Address - Phone:603-942-5694
Mailing Address - Fax:603-942-8194
Practice Address - Street 1:103 FIRST NH TPKE
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:NH
Practice Address - Zip Code:03261-3503
Practice Address - Country:US
Practice Address - Phone:603-942-5694
Practice Address - Fax:603-942-8194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-28
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH05729323363LA2200X
NH04081123363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty