Provider Demographics
NPI:1770199150
Name:BEAUDRY, HEATHER LEE (APRN, CDCES)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEE
Last Name:BEAUDRY
Suffix:
Gender:F
Credentials:APRN, CDCES
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LEE
Other - Last Name:GUAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:133 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-2006
Mailing Address - Country:US
Mailing Address - Phone:603-752-2040
Mailing Address - Fax:
Practice Address - Street 1:133 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-2006
Practice Address - Country:US
Practice Address - Phone:603-752-2040
Practice Address - Fax:603-752-7797
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH071544-21163W00000X
NH748648163WD0400X
NH071544-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH071544-21OtherRN LICENSE
NH071544-23OtherAPRN LICENSE