Provider Demographics
NPI:1750810347
Name:SOTTAK, MEGAN M (APRN)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:M
Last Name:SOTTAK
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:PO BOX 1327
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03247-1327
Mailing Address - Country:US
Mailing Address - Phone:603-934-2060
Mailing Address - Fax:603-527-7038
Practice Address - Street 1:HILLSIDE FAMILY MEDICINE
Practice Address - Street 2:14 MAPLE STREET
Practice Address - City:GILFORD
Practice Address - State:NH
Practice Address - Zip Code:03249-6578
Practice Address - Country:US
Practice Address - Phone:603-527-7114
Practice Address - Fax:603-527-2945
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2018-07-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH056352-23207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3110623Medicaid