Provider Demographics
NPI:1679962575
Name:MOOREHEAD, MARTHA J (APRN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:J
Last Name:MOOREHEAD
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 1:8 OAKCREST LN
Mailing Address - Street 2:
Mailing Address - City:GILMANTON
Mailing Address - State:NH
Mailing Address - Zip Code:03237-4930
Mailing Address - Country:US
Mailing Address - Phone:036-545-5222
Mailing Address - Fax:
Practice Address - Street 1:186 WAUKEWAN ST # 6023
Practice Address - Street 2:
Practice Address - City:MEREDITH
Practice Address - State:NH
Practice Address - Zip Code:03253-6023
Practice Address - Country:US
Practice Address - Phone:603-279-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH057943-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily