Provider Demographics
NPI:1790385532
Name:CONLIN, HEIDE (NH LICENSE # 3402)
Entity Type:Individual
Prefix:
First Name:HEIDE
Middle Name:
Last Name:CONLIN
Suffix:
Gender:F
Credentials:NH LICENSE # 3402
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 RIDGEVIEW TER
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-2070
Mailing Address - Country:US
Mailing Address - Phone:603-377-1333
Mailing Address - Fax:
Practice Address - Street 1:580 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-3347
Practice Address - Country:US
Practice Address - Phone:603-377-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3402374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician