Provider Demographics
NPI:1821519836
Name:KERSHBAUMER, NICHOLAS PETER (APRN)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:PETER
Last Name:KERSHBAUMER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1220
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-1220
Mailing Address - Country:US
Mailing Address - Phone:603-249-3000
Mailing Address - Fax:
Practice Address - Street 1:199 ROUTE 101
Practice Address - Street 2:MEETING PLACE PLAZA
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031
Practice Address - Country:US
Practice Address - Phone:603-249-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH067955-23363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care