Provider Demographics
NPI:1790839009
Name:ROUILLARD, DAVID R (ARNP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:ROUILLARD
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 JASMINE LN
Mailing Address - Street 2:
Mailing Address - City:GOFFSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03045-1954
Mailing Address - Country:US
Mailing Address - Phone:603-497-5659
Mailing Address - Fax:
Practice Address - Street 1:36 CLINTON STREET
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NJ
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-271-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0264423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE4178Medicare UPIN