Provider Demographics
NPI:1255888434
Name:SOUTHERN NEW HAMPSHIRE NURSE PRACTITIONERS LLC
Entity type:Organization
Organization Name:SOUTHERN NEW HAMPSHIRE NURSE PRACTITIONERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, APRN
Authorized Official - Phone:603-866-1881
Mailing Address - Street 1:428 LAFAYETTE RD APT 101
Mailing Address - Street 2:PO BOX 171
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-2268
Mailing Address - Country:US
Mailing Address - Phone:603-395-1724
Mailing Address - Fax:888-979-8717
Practice Address - Street 1:428 LAFAYETTE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-2267
Practice Address - Country:US
Practice Address - Phone:603-395-1724
Practice Address - Fax:888-979-8717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH046771-23261QP2300X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30344609Medicaid
NP5447Medicare PIN
Q72374Medicare UPIN