Provider Demographics
NPI:1760621056
Name:VOJTKO, MARK GALEN (MS, MSNA, APRN-CRNA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:GALEN
Last Name:VOJTKO
Suffix:
Gender:M
Credentials:MS, MSNA, APRN-CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CHARRON CIR
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-1806
Mailing Address - Country:US
Mailing Address - Phone:603-667-7333
Mailing Address - Fax:
Practice Address - Street 1:5 ALUMNI DR
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2128
Practice Address - Country:US
Practice Address - Phone:603-580-6624
Practice Address - Fax:603-580-6620
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH052326-23367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3100526Medicaid
NH000974401Medicare PIN
NH000974401Medicare PIN