Provider Demographics
NPI:1669878179
Name:PALLIATIVITY MEDICAL GROUP LLC
Entity type:Organization
Organization Name:PALLIATIVITY MEDICAL GROUP LLC
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:WITHROW
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C, ACHPN
Authorized Official - Phone:603-785-8406
Mailing Address - Street 1:304 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-6122
Mailing Address - Country:US
Mailing Address - Phone:603-785-8406
Mailing Address - Fax:
Practice Address - Street 1:116 S RIVER RD
Practice Address - Street 2:UNIT D2
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6734
Practice Address - Country:US
Practice Address - Phone:603-785-8406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty