Provider Demographics
NPI:1720734718
Name:VAILLANCOURT, REBECCA JANE (APRN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:VAILLANCOURT
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 1:26 JOAN DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NH
Mailing Address - Zip Code:03032-3215
Mailing Address - Country:US
Mailing Address - Phone:603-591-7966
Mailing Address - Fax:
Practice Address - Street 1:185 QUEEN CITY AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-7121
Practice Address - Country:US
Practice Address - Phone:603-314-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH043784-23363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health