Provider Demographics
NPI:1821571886
Name:DHLIWAYO, THANDIWE
Entity Type:Individual
Prefix:
First Name:THANDIWE
Middle Name:
Last Name:DHLIWAYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 WALNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:GOFFSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03045-2340
Mailing Address - Country:US
Mailing Address - Phone:603-703-6396
Mailing Address - Fax:
Practice Address - Street 1:5 WASHINGTON PL
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6736
Practice Address - Country:US
Practice Address - Phone:603-663-8060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH069915-21163W00000X
NH069915-23363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse