Provider Demographics
NPI:1710501093
Name:PUTNAM, EMILY MAE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MAE
Last Name:PUTNAM
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 1:24 DILLON WAY UNIT 1
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-1759
Mailing Address - Country:US
Mailing Address - Phone:603-832-3833
Mailing Address - Fax:
Practice Address - Street 1:24 DILLON WAY UNIT 1
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-1759
Practice Address - Country:US
Practice Address - Phone:603-832-3833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide