Provider Demographics
NPI:1669115853
Name:LANIGAN, WANDA R (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:R
Last Name:LANIGAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 GREELEY ST STE 23
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-4429
Mailing Address - Country:US
Mailing Address - Phone:603-484-0035
Mailing Address - Fax:
Practice Address - Street 1:22 GREELEY ST STE 23
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-4429
Practice Address - Country:US
Practice Address - Phone:603-484-0035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH046324-21363LP0808X
NH046324-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health