Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 2000006325 | NY |
NPI | 1114384922 |
---|---|
Provider Name | Alyssa Vanpatten |
First Address | Manchester, NH 03104-2449 |
Second Address | Manchester, NH 03104-2449 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2016 |
Last Update Date | 25/01/2016 |