Provider Demographics
NPI:1457874232
Name:GRANITE STATE HEALTH PLLC
Entity type:Organization
Organization Name:GRANITE STATE HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAPP
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-BC
Authorized Official - Phone:603-491-9667
Mailing Address - Street 1:PO BOX 538
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-0538
Mailing Address - Country:US
Mailing Address - Phone:603-491-9667
Mailing Address - Fax:
Practice Address - Street 1:1 ACADEMY STREET
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3724
Practice Address - Country:US
Practice Address - Phone:603-842-4401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-24
Last Update Date:2024-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3102550Medicaid