Provider Demographics
NPI:1952304800
Name:PAQUETTE, ANDREA C (APRN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:C
Last Name:PAQUETTE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 PILLSBURY RD
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3220
Mailing Address - Country:US
Mailing Address - Phone:603-620-3002
Mailing Address - Fax:603-818-8928
Practice Address - Street 1:80 NASHUA RD
Practice Address - Street 2:B2
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3419
Practice Address - Country:US
Practice Address - Phone:603-818-8926
Practice Address - Fax:603-818-8928
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH031942-23363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30349138Medicaid
NH30349138Medicaid
NH30349138Medicaid
NHNP4113Medicare ID - Type UnspecifiedPART B