Provider Demographics
NPI:1811288301
Name:FASSLER, KRISTY LEE (ND)
Entity type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:LEE
Last Name:FASSLER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MARKET ST
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3458
Mailing Address - Country:US
Mailing Address - Phone:603-427-6800
Mailing Address - Fax:603-427-2801
Practice Address - Street 1:500 MARKET ST
Practice Address - Street 2:SUITE 1F
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3458
Practice Address - Country:US
Practice Address - Phone:603-427-6800
Practice Address - Fax:603-427-2801
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH002207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH002OtherLICENSE