Provider Demographics
NPI:1881656650
Name:LAROSE, ANDREA M (ARNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:LAROSE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ELLIOT WAY
Mailing Address - Street 2:NEONATOLOGY SERVICES - ELLIOT HOSPITAL
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3502
Mailing Address - Country:US
Mailing Address - Phone:603-663-2692
Mailing Address - Fax:603-663-3982
Practice Address - Street 1:1 ELLIOT WAY
Practice Address - Street 2:NEONATOLOGY SERVICES - ELLIOT HOSPITAL
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3502
Practice Address - Country:US
Practice Address - Phone:603-663-2692
Practice Address - Fax:603-663-3982
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH031537-23-10363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH40Y002583NH02OtherANTHEM ACES
NHAA5998OtherHPHC PIN
NH669766OtherCIGNA PIN
NH30344388Medicaid
NH22564YOtherANTHEM REFERRING RAN
Q12854Medicare UPIN
NHNP4528Medicare PIN