Provider Demographics
NPI:1679982755
Name:PIBURN, BETSY
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:PIBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SAINT JOHNSBURY RD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561-3442
Mailing Address - Country:US
Mailing Address - Phone:603-444-9000
Mailing Address - Fax:
Practice Address - Street 1:1095 PROFILE RD
Practice Address - Street 2:
Practice Address - City:FRANCONIA
Practice Address - State:NH
Practice Address - Zip Code:03580-4938
Practice Address - Country:US
Practice Address - Phone:603-823-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant