Provider Demographics
NPI:1760970545
Name:GAUDETTE BOWLEY, JACLYN ROSE (APRN)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:ROSE
Last Name:GAUDETTE BOWLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:ROSE
Other - Last Name:GAUDETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7 HOLLAND WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2997
Mailing Address - Country:US
Mailing Address - Phone:603-693-2100
Mailing Address - Fax:603-679-1046
Practice Address - Street 1:212 CALEF HWY
Practice Address - Street 2:
Practice Address - City:EPPING
Practice Address - State:NH
Practice Address - Zip Code:03042
Practice Address - Country:US
Practice Address - Phone:603-693-2100
Practice Address - Fax:603-679-1046
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH066497-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3113797Medicaid